Provider Demographics
NPI:1326483330
Name:ESCOBAR, SERENITY MARROQUIN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SERENITY
Middle Name:MARROQUIN
Last Name:ESCOBAR
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 1:351 SAIPAN PL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-2932
Mailing Address - Country:US
Mailing Address - Phone:210-262-4047
Mailing Address - Fax:
Practice Address - Street 1:101 PEACEFUL LN
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-1007
Practice Address - Country:US
Practice Address - Phone:210-248-9077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66566101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional