Provider Demographics
NPI:1457924169
Name:CAVAZOS, LETICIA L (DSW, LCSW, LCDC)
Entity Type:Individual
Prefix:DR
First Name:LETICIA
Middle Name:L
Last Name:CAVAZOS
Suffix:
Gender:F
Credentials:DSW, LCSW, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15851 DALLAS PKWY
Mailing Address - Street 2:
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3369
Mailing Address - Country:US
Mailing Address - Phone:214-267-9556
Mailing Address - Fax:
Practice Address - Street 1:15851 DALLAS PKWY
Practice Address - Street 2:
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-3369
Practice Address - Country:US
Practice Address - Phone:214-267-9556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-20
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX568351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical