Provider Demographics
NPI:1568173425
Name:CUESTAS, JOHANNA
Entity Type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:
Last Name:CUESTAS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:JOHANNA
Other - Middle Name:
Other - Last Name:CUESTAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 SURREY LN APT 301
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-4158
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4625 COIT RD
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-4926
Practice Address - Country:US
Practice Address - Phone:281-727-8231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional