Healthcare Provider Details

I. General information

NPI: 1518766310
Provider Name (Legal Business Name): BERTHA FABIOLA ESCOBAR LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2025
Last Update Date: 03/12/2025
Certification Date: 03/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 DUKIE DR
BROWNSVILLE TX
78521-5930
US

IV. Provider business mailing address

1221 DUKIE DR
BROWNSVILLE TX
78521-5930
US

V. Phone/Fax

Practice location:
  • Phone: 956-336-7234
  • Fax:
Mailing address:
  • Phone: 956-336-7234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number83573
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: