Provider Demographics
NPI:1740767250
Name:FUENTES, ANNA MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:FUENTES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:TIRRES
Other - Last Name:FUENTES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1933 SHADOW RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-4622
Mailing Address - Country:US
Mailing Address - Phone:915-276-1158
Mailing Address - Fax:
Practice Address - Street 1:1933 SHADOW RIDGE DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-4622
Practice Address - Country:US
Practice Address - Phone:915-276-1158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-26
Last Update Date:2018-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16007101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional