Provider Demographics
NPI:1154548055
Name:CANTU, CONCEPCION (LBSW)
Entity type:Individual
Prefix:MRS
First Name:CONCEPCION
Middle Name:
Last Name:CANTU
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 BROADWAY ST STE A
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7771
Mailing Address - Country:US
Mailing Address - Phone:512-393-5520
Mailing Address - Fax:512-393-5530
Practice Address - Street 1:401 BROADWAY ST STE A
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7771
Practice Address - Country:US
Practice Address - Phone:512-393-5520
Practice Address - Fax:512-393-5530
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40628171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator