Provider Demographics
NPI:1356886873
Name:CORTEZ-CASILLAS, VICTORIA (LPC)
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:
Last Name:CORTEZ-CASILLAS
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 1:124 TEXAS MULBERRY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-5185
Mailing Address - Country:US
Mailing Address - Phone:210-748-2447
Mailing Address - Fax:
Practice Address - Street 1:124 TEXAS MULBERRY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-5185
Practice Address - Country:US
Practice Address - Phone:210-748-2447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-20
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69217101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional