Provider Demographics
NPI:1902198492
Name:CORTEZ, LETICIA (MALPC)
Entity Type:Individual
Prefix:
First Name:LETICIA
Middle Name:
Last Name:CORTEZ
Suffix:
Gender:F
Credentials:MALPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9500 TIOGA DR # A
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-3118
Mailing Address - Country:US
Mailing Address - Phone:210-616-0828
Mailing Address - Fax:855-616-0829
Practice Address - Street 1:9500 TIOGA DR # A
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-3118
Practice Address - Country:US
Practice Address - Phone:210-616-0828
Practice Address - Fax:210-616-0829
Is Sole Proprietor?:No
Enumeration Date:2011-05-03
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX143744403Medicaid
TX1437444-01Medicaid