Healthcare Provider Details

I. General information

NPI: 1255121661
Provider Name (Legal Business Name): ANA SOFIA GUERRA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2025
Last Update Date: 05/08/2025
Certification Date: 05/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 W 51ST ST UNIT 1
AUSTIN TX
78756-2659
US

IV. Provider business mailing address

2504 SAN GABRIEL ST APT 801
AUSTIN TX
78705-4595
US

V. Phone/Fax

Practice location:
  • Phone: 512-201-4501
  • Fax:
Mailing address:
  • Phone: 956-422-4804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: