Healthcare Provider Details

I. General information

NPI: 1154627818
Provider Name (Legal Business Name): GUIDANCE & COUNSELING ASSOCIATES OF LAREDO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2011
Last Update Date: 04/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6510 POLARIS DR STE 2 UNIT 10
LAREDO TX
78041
US

IV. Provider business mailing address

PO BOX 451315
LAREDO TX
78045-0032
US

V. Phone/Fax

Practice location:
  • Phone: 956-284-0779
  • Fax:
Mailing address:
  • Phone: 956-284-0779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number23884
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number23884
License Number StateTX

VIII. Authorized Official

Name: ELIA ELIZA DAVILA
Title or Position: OWNER
Credential: LCSW
Phone: 956-284-0779