Provider Demographics
NPI:1891336632
Name:ANCARANA, PAUL EDWIN (MA, LPC)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:EDWIN
Last Name:ANCARANA
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3613 WILLIAMS DR STE 804
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-1374
Mailing Address - Country:US
Mailing Address - Phone:512-400-4247
Mailing Address - Fax:
Practice Address - Street 1:3613 WILLIAMS DR STE 804
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-1374
Practice Address - Country:US
Practice Address - Phone:512-400-4247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-02
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77503101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health