Provider Demographics
NPI:1922145093
Name:ESPINOZA, GEORGINA (LPC)
Entity Type:Individual
Prefix:
First Name:GEORGINA
Middle Name:
Last Name:ESPINOZA
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 1:4120 RIO BRAVO ST
Mailing Address - Street 2:SUITE 118
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-1052
Mailing Address - Country:US
Mailing Address - Phone:915-433-3473
Mailing Address - Fax:877-606-9254
Practice Address - Street 1:4120 RIO BRAVO ST
Practice Address - Street 2:SUITE 118
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-1052
Practice Address - Country:US
Practice Address - Phone:915-433-3473
Practice Address - Fax:877-606-9254
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19476101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182450003Medicaid