Provider Demographics
NPI:1225874902
Name:TIJERINA, MARIVEL (LPC)
Entity type:Individual
Prefix:MRS
First Name:MARIVEL
Middle Name:
Last Name:TIJERINA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10607 LIBERTY FLD STE 107
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-6405
Mailing Address - Country:US
Mailing Address - Phone:210-816-4353
Mailing Address - Fax:
Practice Address - Street 1:10607 LIBERTY FLD STE 107
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-6405
Practice Address - Country:US
Practice Address - Phone:210-816-4353
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89262101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health