Provider Demographics
NPI:1316196785
Name:SALCEDO, MYRA M (MSW LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MYRA
Middle Name:M
Last Name:SALCEDO
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 N COLLINS BLVD
Mailing Address - Street 2:SUITE 503
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080
Mailing Address - Country:US
Mailing Address - Phone:972-690-6700
Mailing Address - Fax:972-690-6705
Practice Address - Street 1:2007 N COLLINS BLVD
Practice Address - Street 2:SUITE 503
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080
Practice Address - Country:US
Practice Address - Phone:972-690-6700
Practice Address - Fax:972-690-6705
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX42032101Y00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor