Provider Demographics
NPI:1366747107
Name:ELIZONDO, ASTRID A (LPC)
Entity type:Individual
Prefix:
First Name:ASTRID
Middle Name:A
Last Name:ELIZONDO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5622
Mailing Address - Country:US
Mailing Address - Phone:915-887-3453
Mailing Address - Fax:915-351-4702
Practice Address - Street 1:1600 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5622
Practice Address - Country:US
Practice Address - Phone:915-887-3453
Practice Address - Fax:915-351-4702
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-25
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX65256101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional