Healthcare Provider Details

I. General information

NPI: 1639213184
Provider Name (Legal Business Name): LAREDO COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2007
Last Update Date: 02/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 E SAUNDERS ST STE 2
LAREDO TX
78041-5434
US

IV. Provider business mailing address

2320 GUSTAVUS ST
LAREDO TX
78043-2424
US

V. Phone/Fax

Practice location:
  • Phone: 956-729-1991
  • Fax:
Mailing address:
  • Phone: 956-729-1991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: ADRIANA L CRADDOCK
Title or Position: VICE PRESIDENT
Credential: M.A.
Phone: 956-729-1991