Provider Demographics
NPI:1407434657
Name:CANO, MIRNA AZUCENA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:MIRNA
Middle Name:AZUCENA
Last Name:CANO
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 1:1090 SCHOOLHOUSE RD STE 700
Mailing Address - Street 2:
Mailing Address - City:HASLET
Mailing Address - State:TX
Mailing Address - Zip Code:76052-3778
Mailing Address - Country:US
Mailing Address - Phone:682-990-5932
Mailing Address - Fax:
Practice Address - Street 1:1090 SCHOOLHOUSE RD STE 700
Practice Address - Street 2:
Practice Address - City:HASLET
Practice Address - State:TX
Practice Address - Zip Code:76052-3778
Practice Address - Country:US
Practice Address - Phone:682-990-5932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX81707101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional