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General NPI Number Information
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NPI Number | 1063124907
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Entity Type | Individual
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Provider Name | ILIANA MARISOL LANDEROS M.ED., LPC
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Gender | Female
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Dates
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Enumeration Date | 12/22/2022
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Last Update Date | 02/24/2023
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Provider Practice Location Address
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Address Line | 1512 E GRIFFIN PKWY STE 8
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City | MISSION
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State | TX
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Zip | 78572-2416
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Country | US
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Telephone | 956-424-3433
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Fax |
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Provider Business Mailing Address
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Address Line | 225 SANTOS RAMIREZ ST
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City | LA JOYA
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State | TX
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Zip | 78560-4044
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Country | US
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Telephone | 956-467-6376
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 86089
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License Number State | TX
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