Provider Demographics
NPI:1235638420
Name:CANTU, CORINA (M ED, LPC)
Entity Type:Individual
Prefix:
First Name:CORINA
Middle Name:
Last Name:CANTU
Suffix:
Gender:F
Credentials:M ED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 SHADOWBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-3923
Mailing Address - Country:US
Mailing Address - Phone:956-778-1332
Mailing Address - Fax:
Practice Address - Street 1:2115 SHADOWBROOK CIR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-3923
Practice Address - Country:US
Practice Address - Phone:956-778-1332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70854101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty