Provider Demographics
NPI:1467162149
Name:CANTU, CLIFFORD (LCSW)
Entity type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:
Last Name:CANTU
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 HARNESS LN
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-3744
Mailing Address - Country:US
Mailing Address - Phone:817-876-4733
Mailing Address - Fax:
Practice Address - Street 1:12915 JONES MALTSBERGER RD STE 201
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-4540
Practice Address - Country:US
Practice Address - Phone:210-404-4317
Practice Address - Fax:210-817-8722
Is Sole Proprietor?:No
Enumeration Date:2022-12-02
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX623541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical