Provider Demographics
NPI:1275600405
Name:CERVANTES, LISA M (LPC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:M
Last Name:CERVANTES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8505 FOREST LOOP
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-8404
Mailing Address - Country:US
Mailing Address - Phone:956-724-4357
Mailing Address - Fax:956-753-9696
Practice Address - Street 1:802 GALVESTON ST STE A
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-4619
Practice Address - Country:US
Practice Address - Phone:956-724-4357
Practice Address - Fax:956-753-9696
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18539101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional