Provider Demographics
NPI:1639287527
Name:CISNEROS, ANNA AMELIA (LPC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:AMELIA
Last Name:CISNEROS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 SANDRA LYNN DR
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-0920
Mailing Address - Country:US
Mailing Address - Phone:972-746-6311
Mailing Address - Fax:
Practice Address - Street 1:1400 N CORINTH ST STE 109
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:TX
Practice Address - Zip Code:76208-5444
Practice Address - Country:US
Practice Address - Phone:940-448-0304
Practice Address - Fax:972-364-1189
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20205101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional