Provider Demographics
NPI:1972136232
Name:DE LOS SANTOS, KATRINA ANN (LPC)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:ANN
Last Name:DE LOS SANTOS
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:PO BOX 683
Mailing Address - Street 2:
Mailing Address - City:VAIL
Mailing Address - State:AZ
Mailing Address - Zip Code:85641-0683
Mailing Address - Country:US
Mailing Address - Phone:520-904-3345
Mailing Address - Fax:
Practice Address - Street 1:12274 BANDERA RD STE 101
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-4386
Practice Address - Country:US
Practice Address - Phone:210-396-7609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-14
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21611101YP2500X
TX85002101YP2500X
SD20537101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health