Provider Demographics
NPI:1043850589
Name:MANTECON-GARZA, LOURDES (SEXUALITY COUNSELOR)
Entity Type:Individual
Prefix:MRS
First Name:LOURDES
Middle Name:
Last Name:MANTECON-GARZA
Suffix:
Gender:F
Credentials:SEXUALITY COUNSELOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W NOLANA AVE STE 103Q
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-3082
Mailing Address - Country:US
Mailing Address - Phone:956-878-6871
Mailing Address - Fax:
Practice Address - Street 1:711 W NOLANA AVE STE 103Q
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3082
Practice Address - Country:US
Practice Address - Phone:956-878-6871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-13
Last Update Date:2020-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1196149101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
1196149OtherAMERICAN ASSOCIATION OF SEXUALITY EDUCATORS COUNSELORS AND THERAPISTS AASECT