Provider Demographics
NPI:1285319749
Name:CERRITOS, ISABELLA (MA)
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:
Last Name:CERRITOS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17177 PRESTON RD STE 140
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-1235
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:844-496-1266
Practice Address - Street 1:17177 PRESTON RD STE 140
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-1235
Practice Address - Country:US
Practice Address - Phone:972-674-9783
Practice Address - Fax:844-496-1266
Is Sole Proprietor?:No
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89130101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional