Provider Demographics
NPI:1366842742
Name:BANDA, MARIA Y (MS, LPC, CRC)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:Y
Last Name:BANDA
Suffix:
Gender:F
Credentials:MS, LPC, CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W NOLANA AVE STE 103C
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-3082
Mailing Address - Country:US
Mailing Address - Phone:956-867-8841
Mailing Address - Fax:
Practice Address - Street 1:711 W NOLANA AVE STE 103C
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-3082
Practice Address - Country:US
Practice Address - Phone:956-867-8841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-04
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70410101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX341461702Medicaid
TX341461703Medicaid