Provider Demographics
NPI:1083105720
Name:ALVAREZ, CRISTINA MARIE
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:MARIE
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9003 FEATHER BLF
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-3642
Mailing Address - Country:US
Mailing Address - Phone:956-466-6044
Mailing Address - Fax:
Practice Address - Street 1:4500 MERCANTILE PLAZA DR STE 307
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-4230
Practice Address - Country:US
Practice Address - Phone:817-232-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75566101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health