Healthcare Provider Details

I. General information

NPI: 1043047657
Provider Name (Legal Business Name): PRISCILLA LIZARRAGA CISNEROS LPC- ASSOCIATE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4909 S HUMMER LN
EDINBURG TX
78539-3114
US

IV. Provider business mailing address

4909 S HUMMER LN
EDINBURG TX
78539-3114
US

V. Phone/Fax

Practice location:
  • Phone: 626-383-9686
  • Fax:
Mailing address:
  • Phone: 626-383-9686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number96416
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: