Healthcare Provider Details

I. General information

NPI: 1609607720
Provider Name (Legal Business Name): CRISTELA ESCOBEDO MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CRISTELA ESCOBEDO MA, LPC

II. Dates (important events)

Enumeration Date: 08/10/2024
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N BAIRD ST STE 102
MIDLAND TX
79701-4750
US

IV. Provider business mailing address

600 N BAIRD ST STE 102
MIDLAND TX
79701-4750
US

V. Phone/Fax

Practice location:
  • Phone: 432-999-8366
  • Fax:
Mailing address:
  • Phone: 432-999-8366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number91235
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: