Healthcare Provider Details

I. General information

NPI: 1871310631
Provider Name (Legal Business Name): IRANI URENA LPC- ASSOCIATE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1605 SOMBRAS DR
LAREDO TX
78045-4269
US

IV. Provider business mailing address

1605 SOMBRAS DR
LAREDO TX
78045-4269
US

V. Phone/Fax

Practice location:
  • Phone: 956-483-0116
  • Fax:
Mailing address:
  • Phone: 956-483-0116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number96213
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: