Provider Demographics
NPI:1922701994
Name:RUANO ERAZO, NELLY (CFNMP)
Entity Type:Individual
Prefix:
First Name:NELLY
Middle Name:
Last Name:RUANO ERAZO
Suffix:
Gender:F
Credentials:CFNMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 N CARRIER PKWY
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75050-5484
Mailing Address - Country:US
Mailing Address - Phone:682-327-5410
Mailing Address - Fax:
Practice Address - Street 1:517 N CARRIER PKWY
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-5484
Practice Address - Country:US
Practice Address - Phone:682-327-5410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor