Healthcare Provider Details

I. General information

NPI: 1073342242
Provider Name (Legal Business Name): ALEJANDRA CERVANTES LPC-ASSOCIATE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2024
Last Update Date: 07/29/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 BALCONES DR STE 100
AUSTIN TX
78731-4298
US

IV. Provider business mailing address

5900 BALCONES DR STE 100
AUSTIN TX
78731-4298
US

V. Phone/Fax

Practice location:
  • Phone: 979-349-6997
  • Fax:
Mailing address:
  • Phone: 979-349-6997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number94280
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: