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General NPI Number Information
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NPI Number | 1407974447
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Entity Type | Individual
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Provider Name | MARTINA TIJERINA PRADO LBSW, M.ED., LPC
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Gender | Female
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 10/13/2014
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Provider Practice Location Address
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Address Line | 5510 RAPHAEL DRIVE
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City | EDINBURG
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State | TX
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Zip | 78539
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Country | US
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Telephone | 956-362-2890
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Fax | 956-362-2488
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Provider Business Mailing Address
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Address Line | 5510 RAPHAEL DRIVE
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City | EDINBURG
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State | TX
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Zip | 78539
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Country | US
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Telephone | 956-362-2890
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Fax | 956-362-2488
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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 | 61574
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State | TX
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