1265185896 NPI number — MARIAA ANNETTE VILLARREAL MS, LPC

Table of content: LORRIE ANN BOLEN COTA/L (NPI 1487754123)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265185896 NPI number — MARIAA ANNETTE VILLARREAL MS, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VILLARREAL
Provider First Name:
MARIAA ANNETTE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CASTANEDA
Provider Other First Name:
MARIAA ANNETTE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MS, LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1265185896
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5555 AMESBURY DR # 2-307
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75206-3079
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7121 COLLEYVILLE BLVD STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLLEYVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76034-6303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-220-9307
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/02/2022

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: 101YP2500X , with the licence number:  82521 , 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)





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