Provider Demographics
NPI:1396003299
Name:VILLAGOMEZ, KATRINA (MA, LPC)
Entity Type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:
Last Name:VILLAGOMEZ
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:MRS
Other - First Name:KATRINA
Other - Middle Name:
Other - Last Name:MEZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, LPC
Mailing Address - Street 1:PO BOX 8380
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78599-8380
Mailing Address - Country:US
Mailing Address - Phone:956-929-6324
Mailing Address - Fax:
Practice Address - Street 1:402 S NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6024
Practice Address - Country:US
Practice Address - Phone:956-929-6324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67169101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional