Provider Demographics
NPI:1952829061
Name:ALEJO, MYRTHALA
Entity Type:Individual
Prefix:
First Name:MYRTHALA
Middle Name:
Last Name:ALEJO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MYRTHALA
Other - Middle Name:DC
Other - Last Name:ALEJO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:402 JORDAN DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-9141
Mailing Address - Country:US
Mailing Address - Phone:956-337-8843
Mailing Address - Fax:
Practice Address - Street 1:6999 MCPHERSON RD STE 105
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6450
Practice Address - Country:US
Practice Address - Phone:956-608-9744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-08
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74699101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty