Healthcare Provider Details

I. General information

NPI: 1275271124
Provider Name (Legal Business Name): ERIKA DENISE CHAVEZ PENA LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2022
Last Update Date: 11/10/2022
Certification Date: 11/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5522 LONE STAR PKWY STE 303
SAN ANTONIO TX
78253-6722
US

IV. Provider business mailing address

17503 LA CANTERA PKWY STE 104
SAN ANTONIO TX
78257-8209
US

V. Phone/Fax

Practice location:
  • Phone: 210-614-4990
  • Fax:
Mailing address:
  • Phone: 210-664-1275
  • Fax: 210-614-4991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number84440
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: