Provider Demographics
NPI:1760517197
Name:MAYNEZ, LIDIA I (LPC)
Entity Type:Individual
Prefix:MS
First Name:LIDIA
Middle Name:I
Last Name:MAYNEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6623 DAWN DR APT A
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-2970
Mailing Address - Country:US
Mailing Address - Phone:915-449-1634
Mailing Address - Fax:
Practice Address - Street 1:4100 RIO BRAVO ST STE 311
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-1049
Practice Address - Country:US
Practice Address - Phone:915-449-5694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18013101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6204LCOtherBCBS