Healthcare Provider Details

I. General information

NPI: 1912821091
Provider Name (Legal Business Name): LILIANA CANTU MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 JACAMAN RD STE RB-5E
LAREDO TX
78041-6210
US

IV. Provider business mailing address

302 BOB BULLOCK LOOP APT 11103
LAREDO TX
78043-4287
US

V. Phone/Fax

Practice location:
  • Phone: 830-319-4065
  • Fax:
Mailing address:
  • Phone: 830-319-4065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number88642
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: