Provider Demographics
NPI:1891577219
Name:CORONADO TORRES, BRISA CELESTE (LPC)
Entity type:Individual
Prefix:
First Name:BRISA
Middle Name:CELESTE
Last Name:CORONADO TORRES
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 1:4300 W WACO DR STE B2-238
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76710-7010
Mailing Address - Country:US
Mailing Address - Phone:254-548-5805
Mailing Address - Fax:
Practice Address - Street 1:1600 LAKE AIR DR # 121
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76710-2904
Practice Address - Country:US
Practice Address - Phone:254-340-0893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP2500X
TX84892101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional