Provider Demographics
NPI:1033680947
Name:QUINTERO, LYDIA EILEEN (LPC)
Entity type:Individual
Prefix:
First Name:LYDIA
Middle Name:EILEEN
Last Name:QUINTERO
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:PO BOX 2603
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76113-2603
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3301 WEST FWY STE 105
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-5767
Practice Address - Country:US
Practice Address - Phone:817-812-3021
Practice Address - Fax:817-812-3035
Is Sole Proprietor?:No
Enumeration Date:2018-12-17
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional