Provider Demographics
NPI:1851414478
Name:MACIAS, LORETTA (LPC, LCDC)
Entity Type:Individual
Prefix:MS
First Name:LORETTA
Middle Name:
Last Name:MACIAS
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 1:7208 ARROYO SECO
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-2503
Mailing Address - Country:US
Mailing Address - Phone:512-565-6699
Mailing Address - Fax:855-410-3020
Practice Address - Street 1:7208 ARROYO SECO
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-2503
Practice Address - Country:US
Practice Address - Phone:512-565-6699
Practice Address - Fax:855-410-3020
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10188103TA0400X
TX66999101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)