Provider Demographics
NPI:1780750273
Name:BALDERAZ, CONSUELO GAMEZ (LMSW)
Entity type:Individual
Prefix:MRS
First Name:CONSUELO
Middle Name:GAMEZ
Last Name:BALDERAZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:CONNIE
Other - Middle Name:
Other - Last Name:BALDERAZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:7700 FM 2219
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119
Mailing Address - Country:US
Mailing Address - Phone:806-679-9713
Mailing Address - Fax:806-622-1354
Practice Address - Street 1:7700 FM 2219
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119
Practice Address - Country:US
Practice Address - Phone:806-679-9713
Practice Address - Fax:806-622-1354
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31377104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker