Provider Demographics
NPI:1205173515
Name:MOWER, DELORES LEE (LPC)
Entity type:Individual
Prefix:
First Name:DELORES
Middle Name:LEE
Last Name:MOWER
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 1:8202 MONTGOMERY OAK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78239-2965
Mailing Address - Country:US
Mailing Address - Phone:210-324-1069
Mailing Address - Fax:210-324-1069
Practice Address - Street 1:1777 NE LOOP 410 STE 674
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5209
Practice Address - Country:US
Practice Address - Phone:210-324-1069
Practice Address - Fax:210-324-1069
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-07
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX310295602Medicaid