Provider Demographics
NPI:1619603461
Name:ALVAREZ, MIRTHA MARLENE
Entity Type:Individual
Prefix:
First Name:MIRTHA
Middle Name:MARLENE
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MIRTHA
Other - Middle Name:MARLENE
Other - Last Name:RAMIREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9010 MOCCASIN LK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-1839
Mailing Address - Country:US
Mailing Address - Phone:713-874-6729
Mailing Address - Fax:
Practice Address - Street 1:4372 N LOOP 1604 W
Practice Address - Street 2:
Practice Address - City:SHAVANO PARK
Practice Address - State:TX
Practice Address - Zip Code:78249-3486
Practice Address - Country:US
Practice Address - Phone:713-874-6729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-25
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82751101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional