Provider Demographics
NPI:1326592437
Name:MIJARES, SONIA
Entity Type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:MIJARES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 VALLEY VIEW LN
Mailing Address - Street 2:SUITE 855
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062-1721
Mailing Address - Country:US
Mailing Address - Phone:214-441-3797
Mailing Address - Fax:
Practice Address - Street 1:2300 VALLEY VIEW LN
Practice Address - Street 2:SUITE 855
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-1721
Practice Address - Country:US
Practice Address - Phone:214-441-3797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-05
Last Update Date:2016-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70171101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional