Provider Demographics
NPI:1124270194
Name:SOTO, ALICIA T (MA/MFT)
Entity type:Individual
Prefix:MS
First Name:ALICIA
Middle Name:T
Last Name:SOTO
Suffix:
Gender:F
Credentials:MA/MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 N HORNE ST
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-3448
Mailing Address - Country:US
Mailing Address - Phone:310-806-2940
Mailing Address - Fax:
Practice Address - Street 1:315 N HORNE ST
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-3448
Practice Address - Country:US
Practice Address - Phone:310-806-2940
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2017-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA57156106H00000X
TX202916106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist