Provider Demographics
NPI:1508114083
Name:MATAMOROS, ANGELICA YOLANDA (LCDC)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:YOLANDA
Last Name:MATAMOROS
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W CANTON RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-6136
Mailing Address - Country:US
Mailing Address - Phone:956-387-0700
Mailing Address - Fax:956-387-0702
Practice Address - Street 1:500 W CANTON RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-6136
Practice Address - Country:US
Practice Address - Phone:956-387-0700
Practice Address - Fax:956-387-0702
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional