Provider Demographics
NPI:1164906632
Name:CANTERO, ULYSEES T
Entity Type:Individual
Prefix:
First Name:ULYSEES
Middle Name:T
Last Name:CANTERO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 310042
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78131-0042
Mailing Address - Country:US
Mailing Address - Phone:916-718-5760
Mailing Address - Fax:
Practice Address - Street 1:790 GENERATIONS DR STE 410
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-6720
Practice Address - Country:US
Practice Address - Phone:830-625-0599
Practice Address - Fax:830-625-5877
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-20
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12682101YM0800X
CA112536106H00000X
TX90399101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist