Provider Demographics
NPI:1003110354
Name:PENA, EDUARDO DAVID (LPC)
Entity Type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:DAVID
Last Name:PENA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5578
Mailing Address - Country:US
Mailing Address - Phone:915-542-1582
Mailing Address - Fax:915-542-0494
Practice Address - Street 1:1310 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5578
Practice Address - Country:US
Practice Address - Phone:915-542-1582
Practice Address - Fax:915-542-0494
Is Sole Proprietor?:No
Enumeration Date:2010-12-30
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional