Provider Demographics
NPI:1346766474
Name:SERRANO, AILEEN GLORIA (LPC LCDC)
Entity Type:Individual
Prefix:
First Name:AILEEN
Middle Name:GLORIA
Last Name:SERRANO
Suffix:
Gender:F
Credentials:LPC LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6363 DE ZAVALA RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-2103
Mailing Address - Country:US
Mailing Address - Phone:210-431-6466
Mailing Address - Fax:
Practice Address - Street 1:1390 GEORGE DIETER DR STE 140
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7430
Practice Address - Country:US
Practice Address - Phone:915-320-1390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-21
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74729101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health