MEDICARE: DINA CAVAZOS MS, CRC, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	74417	TX

General Provider Information

NPI Number	:	1164903506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DINA CAVAZOS MS, CRC, LPC

Provider Business Mailing Address
First Line	:	8235 AGORA PKWY STE 111 BOX #320
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78154-1335
Country	:	US
Telephone Number	:	210-290-0179
Fax Number	:

Provider Business Practice Location Address
First Line	:	325 E SONTERRA BLVD STE 230
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4056
Country	:	US
Telephone Number	:	210-290-0179
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/23/2018
Last Update Date	:	05/01/2026

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