Provider Demographics
NPI:1376041350
Name:SOUSA, EMILY J (LPC, CEC)
Entity Type:Individual
Prefix:MRS
First Name:EMILY
Middle Name:J
Last Name:SOUSA
Suffix:
Gender:F
Credentials:LPC, CEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CRICKET HOLW
Mailing Address - Street 2:
Mailing Address - City:WIMBERLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78676-2220
Mailing Address - Country:US
Mailing Address - Phone:508-818-7354
Mailing Address - Fax:
Practice Address - Street 1:6 CRICKET HOLW
Practice Address - Street 2:
Practice Address - City:WIMBERLEY
Practice Address - State:TX
Practice Address - Zip Code:78676-2220
Practice Address - Country:US
Practice Address - Phone:508-818-7354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-25
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 101YA0400X, 101YP2500X, 103TC2200X, 106H00000X
TX93388101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist