Provider Demographics
NPI:1386313831
Name:CAVAZOS, LETICIA R (LPC)
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:R
Last Name:CAVAZOS
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 1:11200 PERRIN BEITEL RD APT 116
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-2542
Mailing Address - Country:US
Mailing Address - Phone:956-245-9556
Mailing Address - Fax:
Practice Address - Street 1:11200 PERRIN BEITEL RD APT 116
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-2542
Practice Address - Country:US
Practice Address - Phone:956-245-9556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76523101YP2500X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional