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General NPI Number Information
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NPI Number | 1457504102
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Entity Type | Individual
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Provider Name | ISRAEL PENA LCDC
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Gender | Male
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Dates
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Enumeration Date | 10/28/2008
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Last Update Date | 10/28/2008
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Provider Practice Location Address
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Address Line | 201 S. TYLER STREET
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City | DALLAS
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State | TX
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Zip | 75208
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Country | US
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Telephone | 214-942-5166
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Fax | 214-942-6006
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Provider Business Mailing Address
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Address Line | 201 S TYLER ST
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City | DALLAS
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State | TX
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Zip | 75208-4934
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Country | US
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Telephone | 214-942-5166
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Fax | 214-942-6006
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 4193
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License Number State | TX
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