Provider Demographics
NPI:1265745020
Name:MANZANO, GLORIA PATRICIA (MED, LPC)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:PATRICIA
Last Name:MANZANO
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:GLORIA
Other - Middle Name:
Other - Last Name:MANZANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2208 PRIMROSE, SUITE E
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504
Mailing Address - Country:US
Mailing Address - Phone:956-458-9650
Mailing Address - Fax:
Practice Address - Street 1:2208 PRIMROSE, SUITE E
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504
Practice Address - Country:US
Practice Address - Phone:956-468-3010
Practice Address - Fax:956-468-3011
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-22
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61580101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health