Healthcare Provider Details

I. General information

NPI: 1508319245
Provider Name (Legal Business Name): IRMA ESCOBEDO LPCI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IRMA GUTIERREZ

II. Dates (important events)

Enumeration Date: 07/29/2016
Last Update Date: 07/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MARTIN LUTHER KING BLVD
WICHITA FALLS TX
76301-1152
US

IV. Provider business mailing address

200 MARTIN LUTHER KING BLVD
WICHITA FALLS TX
76301-1152
US

V. Phone/Fax

Practice location:
  • Phone: 940-766-6306
  • Fax: 940-766-6405
Mailing address:
  • Phone: 940-766-6306
  • Fax: 940-766-6405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number76290
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: