Provider Demographics
NPI:1396789566
Name:SERRANO, MIGUEL (LPC)
Entity type:Individual
Prefix:
First Name:MIGUEL
Middle Name:
Last Name:SERRANO
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9019 SWINBURNE CT
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-3637
Mailing Address - Country:US
Mailing Address - Phone:210-248-6618
Mailing Address - Fax:
Practice Address - Street 1:9019 SWINBURNE CT
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-3637
Practice Address - Country:US
Practice Address - Phone:210-248-6618
Practice Address - Fax:210-745-1935
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11008101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX026052301Medicaid