Healthcare Provider Details

I. General information

NPI: 1972124824
Provider Name (Legal Business Name): MARINA ELIA ESCOBAR LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2020
Last Update Date: 07/12/2024
Certification Date: 07/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 W 1ST ST
SAN JUAN TX
78589-2276
US

IV. Provider business mailing address

3118 CENTER POINT DR STE 3
EDINBURG TX
78539-4804
US

V. Phone/Fax

Practice location:
  • Phone: 956-787-0787
  • Fax: 956-787-2021
Mailing address:
  • Phone: 956-687-8000
  • Fax: 956-687-8009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number79843
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: