Provider Demographics
NPI:1598452153
Name:EAGER-ARIZ, KATHLEEN MARA (LPC ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARA
Last Name:EAGER-ARIZ
Suffix:
Gender:F
Credentials:LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:651 BALCONES DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-5935
Mailing Address - Country:US
Mailing Address - Phone:830-623-7121
Mailing Address - Fax:
Practice Address - Street 1:102 PRIMERA DR APT 6
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-2050
Practice Address - Country:US
Practice Address - Phone:830-623-7121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-24
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89421101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health