Healthcare Provider Details

I. General information

NPI: 1952829061
Provider Name (Legal Business Name): MYRTHALA ALEJO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MYRTHALA DC ALEJO LPC

II. Dates (important events)

Enumeration Date: 09/08/2017
Last Update Date: 01/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6999 MCPHERSON RD STE 105
LAREDO TX
78041-6450
US

IV. Provider business mailing address

402 JORDAN DR
LAREDO TX
78041-9141
US

V. Phone/Fax

Practice location:
  • Phone: 956-608-9744
  • Fax:
Mailing address:
  • Phone: 956-337-8843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number74699
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: