Provider Demographics
NPI:1811245095
Name:PERALTA, FRANCISCO ANTONIO
Entity type:Individual
Prefix:MR
First Name:FRANCISCO
Middle Name:ANTONIO
Last Name:PERALTA
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:FRANCISCO
Other - Middle Name:ANTONIO
Other - Last Name:PERALTA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:711 W 38TH ST
Mailing Address - Street 2:SUITE E-2
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1121
Mailing Address - Country:US
Mailing Address - Phone:512-451-2186
Mailing Address - Fax:512-451-1950
Practice Address - Street 1:711 W 38TH ST
Practice Address - Street 2:SUITE E-2
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1121
Practice Address - Country:US
Practice Address - Phone:512-451-2186
Practice Address - Fax:512-451-1950
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9899101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional