Provider Demographics
NPI:1316227192
Name:CENTENO, ERNESTO J (MS, LPC)
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:J
Last Name:CENTENO
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9518 MAJESTIC OAK CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255
Mailing Address - Country:US
Mailing Address - Phone:210-827-1628
Mailing Address - Fax:888-977-3414
Practice Address - Street 1:929 MANOR DR
Practice Address - Street 2:10
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-3267
Practice Address - Country:US
Practice Address - Phone:210-827-1628
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4849101YP2500X
103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4849OtherTEXAS STATE BOARD OF EXAMINERS OF PROFESSIONAL COUNSELORS