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General NPI Number Information
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NPI Number | 1326686965
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Entity Type | Organization
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Legal Business Name | MARIPOSA WELLNESS CENTER, PLLC
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Dates
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Enumeration Date | 12/13/2019
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Last Update Date | 12/13/2019
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Provider Practice Location Address
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Address Line | 4309 N 22ND ST
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City | MCALLEN
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State | TX
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Zip | 78504-4167
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Country | US
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Telephone | 956-960-0164
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Fax |
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Provider Business Mailing Address
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Address Line | 4309 N 22ND ST
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City | MCALLEN
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State | TX
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Zip | 78504-4167
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Country | US
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Telephone | 956-960-0164
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Fax |
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Authorized Official
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Title or Position | FOUNDER/LEAD CLINICIAN
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Name | MS. LUCIA ANNA LEO
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Credential | LCSW-S, BCD
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Telephone | 956-960-0164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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