Provider Demographics
NPI:1174019574
Name:UMANZOR, RAMON JACOB (LPC, LCDC)
Entity Type:Individual
Prefix:
First Name:RAMON
Middle Name:JACOB
Last Name:UMANZOR
Suffix:
Gender:M
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1905 ELDER HILL RD
Mailing Address - Street 2:
Mailing Address - City:DRIFTWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:78619-2102
Mailing Address - Country:US
Mailing Address - Phone:866-380-5420
Mailing Address - Fax:
Practice Address - Street 1:1905 ELDER HILL RD
Practice Address - Street 2:
Practice Address - City:DRIFTWOOD
Practice Address - State:TX
Practice Address - Zip Code:78619-2102
Practice Address - Country:US
Practice Address - Phone:866-380-5420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-09
Last Update Date:2018-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
68784101YM0800X
11970101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)