Provider Demographics
NPI:1730292673
Name:ESCAMILLA, CANDELARIO JR (LPC)
Entity Type:Individual
Prefix:MR
First Name:CANDELARIO
Middle Name:
Last Name:ESCAMILLA
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 DELLWOOD DR.
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045
Mailing Address - Country:US
Mailing Address - Phone:956-723-1675
Mailing Address - Fax:
Practice Address - Street 1:709 E. CALTON RD.
Practice Address - Street 2:STE. 109
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041
Practice Address - Country:US
Practice Address - Phone:956-791-0335
Practice Address - Fax:956-791-0374
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10349101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional