Provider Demographics
NPI:1689907735
Name:LUERA, DELORES DIANE (LPC)
Entity Type:Individual
Prefix:MS
First Name:DELORES
Middle Name:DIANE
Last Name:LUERA
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 1:7910 98TH ST
Mailing Address - Street 2:
Mailing Address - City:WOLFFORTH
Mailing Address - State:TX
Mailing Address - Zip Code:79382-5549
Mailing Address - Country:US
Mailing Address - Phone:806-787-8669
Mailing Address - Fax:806-866-2046
Practice Address - Street 1:8212 ITHACA AVE
Practice Address - Street 2:SUITE W6
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-2632
Practice Address - Country:US
Practice Address - Phone:806-787-8669
Practice Address - Fax:806-866-2046
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2012-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66168101YP2500X
TX30772104100000X
TX8370101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX065363601Medicaid