Provider Demographics
NPI:1871185090
Name:MANDALA COUNSELING & TRAUMA THERAPY CENTER LLC
Entity Type:Organization
Organization Name:MANDALA COUNSELING & TRAUMA THERAPY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VIDAURRI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-675-0066
Mailing Address - Street 1:1534 E 6TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-7239
Mailing Address - Country:US
Mailing Address - Phone:956-275-3232
Mailing Address - Fax:956-338-2994
Practice Address - Street 1:1534 E 6TH ST STE 102
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-7239
Practice Address - Country:US
Practice Address - Phone:956-275-3232
Practice Address - Fax:956-338-2994
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-09
Last Update Date:2021-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty