Provider Demographics
NPI:1306629449
Name:RUVALCABA, GRISELDA (LPC)
Entity type:Individual
Prefix:
First Name:GRISELDA
Middle Name:
Last Name:RUVALCABA
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 1:540 WILLOW LN
Mailing Address - Street 2:
Mailing Address - City:LAVON
Mailing Address - State:TX
Mailing Address - Zip Code:75166-1728
Mailing Address - Country:US
Mailing Address - Phone:972-672-0934
Mailing Address - Fax:
Practice Address - Street 1:540 WILLOW LN
Practice Address - Street 2:
Practice Address - City:LAVON
Practice Address - State:TX
Practice Address - Zip Code:75166-1728
Practice Address - Country:US
Practice Address - Phone:972-672-0934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87493101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health