Provider Demographics
NPI:1598236465
Name:DONSEROUX, DEMETRIUS RANOD (LPC)
Entity Type:Individual
Prefix:
First Name:DEMETRIUS
Middle Name:RANOD
Last Name:DONSEROUX
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30258 SETTERFELD CIR
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78015-2101
Mailing Address - Country:US
Mailing Address - Phone:210-698-6868
Mailing Address - Fax:
Practice Address - Street 1:19595 IH 10 W
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-9520
Practice Address - Country:US
Practice Address - Phone:210-698-6868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60509753101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health