Provider Demographics
NPI:1750689444
Name:HINOJOSA, ILEANA CATARINA (MLA, MAC)
Entity Type:Individual
Prefix:
First Name:ILEANA
Middle Name:CATARINA
Last Name:HINOJOSA
Suffix:
Gender:F
Credentials:MLA, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815A BRAZOS ST # 329
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-2502
Mailing Address - Country:US
Mailing Address - Phone:512-712-0542
Mailing Address - Fax:512-804-1770
Practice Address - Street 1:314 E HIGHLAND MALL BLVD
Practice Address - Street 2:508
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78752-3735
Practice Address - Country:US
Practice Address - Phone:512-712-0542
Practice Address - Fax:512-804-1770
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-04
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201463106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
12165814OtherCAQH