Provider Demographics
NPI:1376620237
Name:CAVAZOS, DELISE (LPC)
Entity Type:Individual
Prefix:
First Name:DELISE
Middle Name:
Last Name:CAVAZOS
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 1:525 W WISCONSIN RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-3018
Mailing Address - Country:US
Mailing Address - Phone:956-287-9754
Mailing Address - Fax:956-287-9764
Practice Address - Street 1:525 W WISCONSIN RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-3018
Practice Address - Country:US
Practice Address - Phone:956-287-9754
Practice Address - Fax:956-287-9764
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2012-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17877101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164728101Medicaid