Provider Demographics
NPI:1487698437
Name:ZALDIVAR, AGNES (LPC)
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:
Last Name:ZALDIVAR
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 1:10022 TERRACE PARK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-5141
Mailing Address - Country:US
Mailing Address - Phone:210-771-7086
Mailing Address - Fax:
Practice Address - Street 1:10022 TERRACE PARK
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-5141
Practice Address - Country:US
Practice Address - Phone:210-771-7086
Practice Address - Fax:210-738-8025
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17551101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional