Provider Demographics
NPI:1497949317
Name:PENA, SANTA E (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SANTA
Middle Name:E
Last Name:PENA
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 1:3118 CENTER POINTE DR.
Mailing Address - Street 2:SUITE 3
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539
Mailing Address - Country:US
Mailing Address - Phone:956-687-8000
Mailing Address - Fax:956-687-8009
Practice Address - Street 1:3118 CENTER POINTE DR.
Practice Address - Street 2:SUITE 3
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539
Practice Address - Country:US
Practice Address - Phone:956-687-8000
Practice Address - Fax:956-687-8009
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2012-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX58212101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185926601Medicaid
TX1859266-01Medicaid