Healthcare Provider Details

I. General information

NPI: 1326466558
Provider Name (Legal Business Name): ALICIA TIJERINA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2014
Last Update Date: 06/12/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1714 S COOPER ST
ARLINGTON TX
76013-3939
US

IV. Provider business mailing address

1714 S COOPER ST
ARLINGTON TX
76013-3939
US

V. Phone/Fax

Practice location:
  • Phone: 817-376-9841
  • Fax: 682-712-0168
Mailing address:
  • Phone: 817-376-9841
  • Fax: 682-712-0168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number12693
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: