Provider Demographics
NPI:1801430822
Name:HEREDIA, JUSTINA OZUNA (LCDC, LPC)
Entity type:Individual
Prefix:MRS
First Name:JUSTINA
Middle Name:OZUNA
Last Name:HEREDIA
Suffix:
Gender:F
Credentials:LCDC, LPC
Other - Prefix:MISS
Other - First Name:JUSTINE
Other - Middle Name:ANTOINETTE
Other - Last Name:OZUNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCDC, LPC
Mailing Address - Street 1:3425 YMCA DR APT 60
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-7180
Mailing Address - Country:US
Mailing Address - Phone:210-288-0567
Mailing Address - Fax:
Practice Address - Street 1:3425 YMCA DR APT 60
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-7180
Practice Address - Country:US
Practice Address - Phone:210-288-0567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-01
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78092101YP2500X
TX12620101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)