Provider Demographics
NPI:1558033266
Name:FLORES, LILEANNA NICOLE (LMSW)
Entity Type:Individual
Prefix:
First Name:LILEANNA
Middle Name:NICOLE
Last Name:FLORES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 W BEAUREGARD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-4004
Mailing Address - Country:US
Mailing Address - Phone:325-658-7750
Mailing Address - Fax:325-658-8381
Practice Address - Street 1:202 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-4842
Practice Address - Country:US
Practice Address - Phone:325-658-7750
Practice Address - Fax:325-658-8381
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX106045104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX106045OtherLMSW LICENSE