Provider Demographics
NPI:1144059569
Name:PONCIANO, ANA LISETH (LMSW)
Entity type:Individual
Prefix:MRS
First Name:ANA
Middle Name:LISETH
Last Name:PONCIANO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N CENTRAL EXPY STE 503
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-5361
Mailing Address - Country:US
Mailing Address - Phone:214-531-7716
Mailing Address - Fax:
Practice Address - Street 1:100 N CENTRAL EXPY STE 503
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-5361
Practice Address - Country:US
Practice Address - Phone:214-531-7716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-01
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX113154101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty