Provider Demographics
NPI:1619611274
Name:ROMAN, ELSA M (LPC-A)
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:M
Last Name:ROMAN
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 S TEXAS BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-6287
Mailing Address - Country:US
Mailing Address - Phone:956-261-5311
Mailing Address - Fax:956-999-8456
Practice Address - Street 1:522 S TEXAS BLVD STE 108
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6287
Practice Address - Country:US
Practice Address - Phone:956-261-5311
Practice Address - Fax:956-999-8456
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2022-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88089101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional