Provider Demographics
NPI:1588080659
Name:ZAVALA, MARIA (MS, LMFT, LPC)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:ZAVALA
Suffix:
Gender:F
Credentials:MS, LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24420 FM 1314 RD STE 17
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-5490
Mailing Address - Country:US
Mailing Address - Phone:346-800-2625
Mailing Address - Fax:281-747-9434
Practice Address - Street 1:24420 FM 1314 RD STE 17
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-5490
Practice Address - Country:US
Practice Address - Phone:346-800-2625
Practice Address - Fax:281-747-9434
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-12
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202184106H00000X
TX72137101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX363127701Medicaid