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General NPI Number Information
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NPI Number | 1306188917
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Entity Type | Organization
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Legal Business Name | SARA A CANTU CORP
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Dates
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Enumeration Date | 03/21/2013
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Last Update Date | 03/21/2013
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Provider Practice Location Address
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Address Line | 1751 BROAD PARK CIR S SUITE 207
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City | MANSFIELD
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State | TX
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Zip | 76063-7826
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Country | US
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Telephone | 214-288-0202
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Fax | 817-473-7787
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Provider Business Mailing Address
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Address Line | 401 MEADOWBROOK DR
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City | ARLINGTON
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State | TX
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Zip | 76010-2035
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Country | US
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Telephone | 214-288-0202
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Fax | 817-473-7787
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Authorized Official
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Title or Position | OWNER
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Name | MS. SARA ANNE CANTU
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Credential | LPC-S RPT-S
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Telephone | 214-288-0202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State | TX
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