Provider Demographics
NPI:1043542582
Name:CAVAZOS, NANCY LEE (LCPC)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:LEE
Last Name:CAVAZOS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4937 S JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-7228
Mailing Address - Country:US
Mailing Address - Phone:956-616-9651
Mailing Address - Fax:956-331-8893
Practice Address - Street 1:4937 S JACKSON RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-7228
Practice Address - Country:US
Practice Address - Phone:956-616-9651
Practice Address - Fax:956-331-8893
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2020-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2718101YP2500X, 101YM0800X
TX82501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX405760601Medicaid