Provider Demographics
NPI:1710465729
Name:LUEVANOS, MOLLY DIANE (LPC)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:DIANE
Last Name:LUEVANOS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:DIANE
Other - Last Name:LUEVANOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:1418 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5618
Mailing Address - Country:US
Mailing Address - Phone:915-351-4431
Mailing Address - Fax:915-566-1811
Practice Address - Street 1:1418 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5618
Practice Address - Country:US
Practice Address - Phone:915-351-4431
Practice Address - Fax:915-566-1811
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-01
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX75091101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional