Provider Demographics
NPI:1093494775
Name:LEDEZMA, CASSANDRA JEAN (LPC)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:JEAN
Last Name:LEDEZMA
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 1:10011 STAGECOACH BAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-5904
Mailing Address - Country:US
Mailing Address - Phone:210-326-7202
Mailing Address - Fax:
Practice Address - Street 1:4081 DE ZAVALA RD STE 201
Practice Address - Street 2:
Practice Address - City:SHAVANO PARK
Practice Address - State:TX
Practice Address - Zip Code:78249-2082
Practice Address - Country:US
Practice Address - Phone:210-326-7202
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87767101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health