Provider Demographics
NPI:1922654243
Name:ELIZONDO CARRANZA, ANAKAREN DE JESUS
Entity Type:Individual
Prefix:
First Name:ANAKAREN
Middle Name:DE JESUS
Last Name:ELIZONDO CARRANZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 WESTLAKE DR STE 105
Mailing Address - Street 2:
Mailing Address - City:WEST LAKE HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78746-9818
Mailing Address - Country:US
Mailing Address - Phone:512-813-7272
Mailing Address - Fax:
Practice Address - Street 1:102 WESTLAKE DR STE 105
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-9818
Practice Address - Country:US
Practice Address - Phone:512-813-7272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44050196106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician