Provider Demographics
NPI:1851058499
Name:VILLARREAL, SELINA GUERRA (LPC, LCDC)
Entity Type:Individual
Prefix:MRS
First Name:SELINA
Middle Name:GUERRA
Last Name:VILLARREAL
Suffix:
Gender:F
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 MERLIN RD
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-2836
Mailing Address - Country:US
Mailing Address - Phone:956-693-0567
Mailing Address - Fax:
Practice Address - Street 1:7220 BUILDING A BOB BULLOCK LP., STE. 306
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-7804
Practice Address - Country:US
Practice Address - Phone:956-693-0567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12728101YA0400X
TX78644101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)