Provider Demographics
NPI:1689298762
Name:URBINA, TERESA CRYSTAL (LPC)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:CRYSTAL
Last Name:URBINA
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 1:13486 HALIFAX ST
Mailing Address - Street 2:
Mailing Address - City:HORIZON CITY
Mailing Address - State:TX
Mailing Address - Zip Code:79928-7302
Mailing Address - Country:US
Mailing Address - Phone:915-929-2804
Mailing Address - Fax:
Practice Address - Street 1:13486 HALIFAX ST
Practice Address - Street 2:
Practice Address - City:HORIZON CITY
Practice Address - State:TX
Practice Address - Zip Code:79928-7302
Practice Address - Country:US
Practice Address - Phone:915-929-2804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX79850101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional