Provider Demographics
NPI:1497366850
Name:REZA, SALANNA (LPC)
Entity Type:Individual
Prefix:
First Name:SALANNA
Middle Name:
Last Name:REZA
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 1:503 PHILLIP ST
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-4730
Mailing Address - Country:US
Mailing Address - Phone:214-916-8229
Mailing Address - Fax:
Practice Address - Street 1:503 PHILLIP ST
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-4730
Practice Address - Country:US
Practice Address - Phone:214-916-8229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80841101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor