Provider Demographics
NPI:1811228281
Name:PEDERSON, NEREYDA G (LPC)
Entity Type:Individual
Prefix:MS
First Name:NEREYDA
Middle Name:G
Last Name:PEDERSON
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 1:206 HUNTERS BRANCH S
Mailing Address - Street 2:
Mailing Address - City:SHAVANO PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1208
Mailing Address - Country:US
Mailing Address - Phone:210-882-8466
Mailing Address - Fax:210-314-4498
Practice Address - Street 1:13330 BLANCO RD
Practice Address - Street 2:#606
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-2193
Practice Address - Country:US
Practice Address - Phone:210-882-8466
Practice Address - Fax:210-314-4449
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-24
Last Update Date:2010-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19897101YP2500X, 103TC1900X, 103TF0000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist