Provider Demographics
NPI:1215244165
Name:PURA VIDA COUNSELING SERVICES PLLC
Entity type:Organization
Organization Name:PURA VIDA COUNSELING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:LACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-227-5239
Mailing Address - Street 1:918 WEST NOLANA LOOP
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577
Mailing Address - Country:US
Mailing Address - Phone:956-227-5239
Mailing Address - Fax:
Practice Address - Street 1:918 WEST NOLANA LOOP
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-8340
Practice Address - Country:US
Practice Address - Phone:956-227-5239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health