Provider Demographics
NPI:1710763719
Name:MONSIVAIS, VANESSA ANGELA (LCDC)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:ANGELA
Last Name:MONSIVAIS
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 PALUXY DR STE 404
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-1617
Mailing Address - Country:US
Mailing Address - Phone:323-522-2218
Mailing Address - Fax:
Practice Address - Street 1:3800 PALUXY DR STE 404
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1617
Practice Address - Country:US
Practice Address - Phone:323-522-2218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-05
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10818101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)