Provider Demographics
NPI:1023532496
Name:MCLEMORE, PRISCILLA VIANA (MA, LPC, LCDC)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:VIANA
Last Name:MCLEMORE
Suffix:
Gender:F
Credentials:MA, LPC, LCDC
Other - Prefix:
Other - First Name:PRISCILLA
Other - Middle Name:VIANA
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:527 ROBLE VIS
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3113
Mailing Address - Country:US
Mailing Address - Phone:936-661-4218
Mailing Address - Fax:210-874-5234
Practice Address - Street 1:527 ROBLE VIS
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3113
Practice Address - Country:US
Practice Address - Phone:936-661-4218
Practice Address - Fax:210-874-5234
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-27
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14123101YA0400X
TX71273101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)