Provider Demographics
NPI:1841734449
Name:MOLINA CONDAL, MARIO ALEJANDRO (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARIO
Middle Name:ALEJANDRO
Last Name:MOLINA CONDAL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MARIO
Other - Middle Name:ALEJANDRO
Other - Last Name:MOLINA CONDAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD, MS
Mailing Address - Street 1:914 COBBLE GATE DR
Mailing Address - Street 2:
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-9195
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:914 COBBLE GATE DR
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-9195
Practice Address - Country:US
Practice Address - Phone:979-383-4781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-15
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX86312101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health