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General NPI Number Information
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NPI Number | 1134734320
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Entity Type | Individual
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Provider Name | CLARISSA ANAHI CANTU
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Gender | Female
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Dates
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Enumeration Date | 09/14/2020
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Last Update Date | 09/14/2020
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Provider Practice Location Address
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Address Line | 2550 WESLACO RD APT G1
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City | BROWNSVILLE
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State | TX
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Zip | 78520-7459
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Country | US
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Telephone | 956-437-9044
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Fax |
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Provider Business Mailing Address
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Address Line | 2550 WESLACO RD APT G1
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City | BROWNSVILLE
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State | TX
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Zip | 78520-7459
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Country | US
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Telephone | 956-437-9044
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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 | 81089
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License Number State | TX
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