Healthcare Provider Details

I. General information

NPI: 1326483330
Provider Name (Legal Business Name): SERENITY MARROQUIN ESCOBAR LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2013
Last Update Date: 05/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PEACEFUL LN
CONVERSE TX
78109-1007
US

IV. Provider business mailing address

351 SAIPAN PL
SAN ANTONIO TX
78221-2932
US

V. Phone/Fax

Practice location:
  • Phone: 210-248-9077
  • Fax:
Mailing address:
  • Phone: 210-262-4047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number66566
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: