Provider Demographics
NPI:1396884912
Name:ALANIZ, MATILDE B (LPC,RPT-I)
Entity type:Individual
Prefix:MRS
First Name:MATILDE
Middle Name:B
Last Name:ALANIZ
Suffix:
Gender:F
Credentials:LPC,RPT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1454
Mailing Address - Street 2:
Mailing Address - City:ROMA
Mailing Address - State:TX
Mailing Address - Zip Code:78584-1454
Mailing Address - Country:US
Mailing Address - Phone:956-849-4192
Mailing Address - Fax:956-849-1118
Practice Address - Street 1:23 HACKBERRY LN
Practice Address - Street 2:
Practice Address - City:ROMA
Practice Address - State:TX
Practice Address - Zip Code:78584-6640
Practice Address - Country:US
Practice Address - Phone:956-849-4192
Practice Address - Fax:956-849-1118
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX57899101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM12171972Medicaid