Provider Demographics
NPI:1518668250
Name:CANTU, SANDRA (MED, LPC, MBA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:CANTU
Suffix:
Gender:F
Credentials:MED, LPC, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17549 ARROYO BANK DRIVE
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78552
Mailing Address - Country:US
Mailing Address - Phone:956-536-0565
Mailing Address - Fax:
Practice Address - Street 1:2106 TREASURE HILLS BLVD
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8736
Practice Address - Country:US
Practice Address - Phone:956-249-6330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX73016101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional