Provider Demographics
NPI:1174856876
Name:CORRAL, VIVIAN JORDAN (LMSW)
Entity Type:Individual
Prefix:
First Name:VIVIAN
Middle Name:JORDAN
Last Name:CORRAL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:VIVIAN
Other - Middle Name:JORDAN
Other - Last Name:CORRAL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:1001 MONTANA AVE
Mailing Address - Street 2:EL PASO HUMAN SERVICES
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5411
Mailing Address - Country:US
Mailing Address - Phone:915-534-7227
Mailing Address - Fax:
Practice Address - Street 1:1001 MONTANA AVE
Practice Address - Street 2:EL PASO HUMAN SERVICES
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5411
Practice Address - Country:US
Practice Address - Phone:915-534-7227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-12
Last Update Date:2011-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30836104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker