Provider Demographics
NPI:1710995253
Name:MONGE, SIOMARA I (LPC)
Entity Type:Individual
Prefix:MS
First Name:SIOMARA
Middle Name:I
Last Name:MONGE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:SIOMARA
Other - Middle Name:I
Other - Last Name:MONGE-LEVERETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:5005 W ROYAL LN STE 271
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-2754
Mailing Address - Country:US
Mailing Address - Phone:214-492-1975
Mailing Address - Fax:214-492-1935
Practice Address - Street 1:5005 W ROYAL LN STE 271
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-2754
Practice Address - Country:US
Practice Address - Phone:214-492-1975
Practice Address - Fax:214-492-1935
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18333101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10034577OtherAMERIGROUP
TX363495OtherMANAGED HEALTH NETWORK
TX268286OtherCOMPSYCH
TX7133LCOtherBCBS