Healthcare Provider Details

I. General information

NPI: 1396239513
Provider Name (Legal Business Name): TINA CISNEROS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 12/20/2023
Certification Date: 12/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 HAVEN FOR HOPE WAY
SAN ANTONIO TX
78207-1266
US

IV. Provider business mailing address

6800 PARK TEN BLVD STE 200S
SAN ANTONIO TX
78213-4293
US

V. Phone/Fax

Practice location:
  • Phone: 210-261-1521
  • Fax: 210-261-1808
Mailing address:
  • Phone: 210-261-1000
  • Fax: 210-261-1821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number73953
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: