1093272924 NPI number — MRS. MARCELLA DE LA REZA LPC, LCDC

Table of content: MRS. MARCELLA DE LA REZA LPC, LCDC (NPI 1093272924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093272924 NPI number — MRS. MARCELLA DE LA REZA LPC, LCDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DE LA REZA
Provider First Name:
MARCELLA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPC, LCDC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DE LA REZA
Provider Other First Name:
MARCELLA
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC,LCDC
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1093272924
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6510 CRESTA BONITA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79912-2412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-491-9657
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
220 THUNDERBIRD DR STE 15
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79912-3911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-491-9657
Provider Business Practice Location Address Fax Number:
915-257-6501
Provider Enumeration Date:
02/27/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  71725 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com