Provider Demographics
NPI:1457360786
Name:HENRICKSON, ANIVAL CANO (LPC)
Entity Type:Individual
Prefix:
First Name:ANIVAL
Middle Name:CANO
Last Name:HENRICKSON
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 1:2529 W TRENTON RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-5070
Mailing Address - Country:US
Mailing Address - Phone:956-994-3880
Mailing Address - Fax:956-994-3877
Practice Address - Street 1:2529 W TRENTON RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-5070
Practice Address - Country:US
Practice Address - Phone:956-994-3880
Practice Address - Fax:956-994-3877
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17711101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1509978Medicaid