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General NPI Number Information
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NPI Number | 1316215635
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Entity Type | Individual
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Provider Name | IVETH PACHECO LPC
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Gender | Female
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Dates
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Enumeration Date | 12/01/2011
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Last Update Date | 12/01/2011
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Provider Practice Location Address
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Address Line | 1524 S IH 35 210
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City | AUSTIN
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State | TX
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Zip | 78704-8931
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Country | US
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Telephone | 512-434-8606
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Fax |
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Provider Business Mailing Address
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Address Line | 4212 MEDICAL DR 403
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City | SAN ANTONIO
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State | TX
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Zip | 78229-5388
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Country | US
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Telephone | 956-493-3083
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 65648
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License Number State | TX
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