Provider Demographics
NPI:1447738687
Name:BALDERRAMA, BIANCA M (LPC)
Entity Type:Individual
Prefix:
First Name:BIANCA
Middle Name:M
Last Name:BALDERRAMA
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 1:2300 GEORGE DIETER DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-3963
Mailing Address - Country:US
Mailing Address - Phone:915-861-5065
Mailing Address - Fax:915-975-8304
Practice Address - Street 1:2300 GEORGE DIETER DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-3963
Practice Address - Country:US
Practice Address - Phone:915-861-5065
Practice Address - Fax:915-975-8304
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77057101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional