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General NPI Number Information
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NPI Number | 1871185090
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Entity Type | Organization
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Legal Business Name | MANDALA COUNSELING & TRAUMA THERAPY CENTER LLC
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Dates
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Enumeration Date | 02/09/2021
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Last Update Date | 09/27/2021
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Provider Practice Location Address
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Address Line | 1534 E 6TH ST STE 102
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City | BROWNSVILLE
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State | TX
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Zip | 78520-7239
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Country | US
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Telephone | 956-275-3232
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Fax | 956-338-2994
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Provider Business Mailing Address
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Address Line | 1534 E 6TH ST STE 102
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City | BROWNSVILLE
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State | TX
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Zip | 78520-7239
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Country | US
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Telephone | 956-275-3232
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Fax | 956-338-2994
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MR. DANIEL VIDAURRI
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Credential |
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Telephone | 210-675-0066
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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 |
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License Number State |
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