Provider Demographics
NPI:1043794761
Name:LEOS, LORENZO JR (LPC)
Entity Type:Individual
Prefix:
First Name:LORENZO
Middle Name:
Last Name:LEOS
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:ENZO
Other - Middle Name:
Other - Last Name:LEOS
Other - Suffix:
Other - Last Name Type:Other Name
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:210-517-8404
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:210-517-8404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-18
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74272101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty