Provider Demographics
NPI:1003448291
Name:VILLAREAL, LETICIA RIOS (LPC)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:RIOS
Last Name:VILLAREAL
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 1:11107 WURZBACH RD STE 104
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-2553
Mailing Address - Country:US
Mailing Address - Phone:210-548-6767
Mailing Address - Fax:
Practice Address - Street 1:11107 WURZBACH RD STE 104
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-2553
Practice Address - Country:US
Practice Address - Phone:210-548-6767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-06
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77680101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX77680OtherLICENSED PROFESSIONAL COUNSELOR LICENSE