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NPI Code Detail

MEDICARE: TINA CISNEROS LPC

MEDICARE: TINA CISNEROS 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
1101YP2500XProfessional Counselor73953TX

General Provider Information

NPI Number : 1396239513
Entity Type Code : Individual
Provider Name (Legal Business Name) : TINA CISNEROS LPC
Provider Business Mailing Address
First Line : 6800 PARK TEN BLVD STE 200S
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78213-4293
Country : US
Telephone Number : 210-261-1000
Fax Number : 210-261-1821
Provider Business Practice Location Address
First Line : 1 HAVEN FOR HOPE WAY
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78207-1266
Country : US
Telephone Number : 210-261-1521
Fax Number : 210-261-1808
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2018
Last Update Date : 12/20/2023

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Directions to “ TINA CISNEROS LPC” Practice Location

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