Healthcare Provider Details

I. General information

NPI: 1083732655
Provider Name (Legal Business Name): GUADALUPE ESCAMILLA PHD, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 RAWLINS ST 102
DALLAS TX
75219-3649
US

IV. Provider business mailing address

PO BOX 192126
DALLAS TX
75219-8513
US

V. Phone/Fax

Practice location:
  • Phone: 214-288-8093
  • Fax: 214-522-8095
Mailing address:
  • Phone: 214-288-8093
  • Fax: 214-522-8095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number20038
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: