Provider Demographics
NPI:1407093578
Name:FLORES, IRASEMA (MED, LPC)
Entity type:Individual
Prefix:
First Name:IRASEMA
Middle Name:
Last Name:FLORES
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1605 GEORGE DIETER DR STE 536
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-5600
Mailing Address - Country:US
Mailing Address - Phone:915-671-1371
Mailing Address - Fax:915-219-9022
Practice Address - Street 1:1612 N LEE TREVINO DR STE A
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-5177
Practice Address - Country:US
Practice Address - Phone:915-329-4575
Practice Address - Fax:855-890-7726
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63889101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX198896601Medicaid