Provider Demographics
NPI:1083163851
Name:CANTU, BELEN ELIZA (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:BELEN
Middle Name:ELIZA
Last Name:CANTU
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11111 CAPISTRAN LOOP
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-7131
Mailing Address - Country:US
Mailing Address - Phone:956-229-8211
Mailing Address - Fax:
Practice Address - Street 1:11111 CAPISTRAN LOOP
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-7131
Practice Address - Country:US
Practice Address - Phone:956-229-8211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72056101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional