Healthcare Provider Details

I. General information

NPI: 1063145860
Provider Name (Legal Business Name): INES SERRANO RIVERA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2022
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 GARTH RD STE AND400
BAYTOWN TX
77521-3153
US

IV. Provider business mailing address

4301 GARTH RD STE AND400
BAYTOWN TX
77521-3153
US

V. Phone/Fax

Practice location:
  • Phone: 713-674-3326
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number84690
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: