Provider Demographics
NPI:1093281669
Name:AGUILERA, MAGDALENA R (LPC)
Entity Type:Individual
Prefix:
First Name:MAGDALENA
Middle Name:R
Last Name:AGUILERA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5606 N NAVARRO ST STE 200
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-1758
Mailing Address - Country:US
Mailing Address - Phone:361-333-1283
Mailing Address - Fax:
Practice Address - Street 1:1402 VILLAGE DR STE A
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-4157
Practice Address - Country:US
Practice Address - Phone:361-894-8734
Practice Address - Fax:361-894-8735
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-22
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76392101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX832248315Other01