Provider Demographics
NPI:1093603821
Name:BERROUT, LETICIA
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:BERROUT
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6082 GRAPEVINE LOOP
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-2229
Mailing Address - Country:US
Mailing Address - Phone:956-466-0494
Mailing Address - Fax:
Practice Address - Street 1:1101 VINE AVE STE B&D
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-4079
Practice Address - Country:US
Practice Address - Phone:956-451-1673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional