Healthcare Provider Details

I. General information

NPI: 1851414478
Provider Name (Legal Business Name): LORETTA MACIAS LPC, LCDC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 09/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7208 ARROYO SECO
AUSTIN TX
78757-2503
US

IV. Provider business mailing address

7208 ARROYO SECO
AUSTIN TX
78757-2503
US

V. Phone/Fax

Practice location:
  • Phone: 512-565-6699
  • Fax: 855-410-3020
Mailing address:
  • Phone: 512-565-6699
  • Fax: 855-410-3020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number10188
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number66999
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: