Provider Demographics
NPI:1336585439
Name:CAVAZOS, MARISELA (LPC)
Entity Type:Individual
Prefix:
First Name:MARISELA
Middle Name:
Last Name:CAVAZOS
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 1:3118 CENTER POINT DR
Mailing Address - Street 2:SUITE 3
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-4804
Mailing Address - Country:US
Mailing Address - Phone:956-687-8000
Mailing Address - Fax:956-687-8009
Practice Address - Street 1:3118 CENTER POINT DR
Practice Address - Street 2:SUITE 3
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-4804
Practice Address - Country:US
Practice Address - Phone:956-687-8000
Practice Address - Fax:956-687-8009
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-15
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68619101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX68619OtherLICENSE
TX3217309-01Medicaid