Provider Demographics
NPI:1255349478
Name:VILLARREAL, MARIA G (LPC)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:G
Last Name:VILLARREAL
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 1:1109 N COOPER ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76011-5545
Mailing Address - Country:US
Mailing Address - Phone:817-860-4080
Mailing Address - Fax:817-860-4082
Practice Address - Street 1:1109 N COOPER ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-5545
Practice Address - Country:US
Practice Address - Phone:817-860-4080
Practice Address - Fax:817-860-4082
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLPC10689101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1657LCOtherBLUE CROSS
TX025911101OtherMEDICAID