Healthcare Provider Details

I. General information

NPI: 1396884912
Provider Name (Legal Business Name): MATILDE B. ALANIZ LPC,RPT-I
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 HACKBERRY LN
ROMA TX
78584-6640
US

IV. Provider business mailing address

PO BOX 1454
ROMA TX
78584-1454
US

V. Phone/Fax

Practice location:
  • Phone: 956-849-4192
  • Fax: 956-849-1118
Mailing address:
  • Phone: 956-849-4192
  • Fax: 956-849-1118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number57899
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: