Provider Demographics
NPI:1891969085
Name:ELIZONDO, GUADALUPE I (LPC)
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:I
Last Name:ELIZONDO
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 1:7706 CROOKED ROAD ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-2613
Mailing Address - Country:US
Mailing Address - Phone:210-421-3287
Mailing Address - Fax:210-845-1547
Practice Address - Street 1:7706 CROOKED ROAD ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-2613
Practice Address - Country:US
Practice Address - Phone:210-421-3287
Practice Address - Fax:210-845-1547
Is Sole Proprietor?:No
Enumeration Date:2008-04-17
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12508101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor