Provider Demographics
NPI:1144655705
Name:VIA, TONY (LPCI)
Entity type:Individual
Prefix:
First Name:TONY
Middle Name:
Last Name:VIA
Suffix:
Gender:M
Credentials:LPCI
Other - Prefix:
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:VIA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:211 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:TX
Mailing Address - Zip Code:76645-3322
Mailing Address - Country:US
Mailing Address - Phone:214-724-0700
Mailing Address - Fax:214-245-5918
Practice Address - Street 1:211 E ELM ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:TX
Practice Address - Zip Code:76645-3322
Practice Address - Country:US
Practice Address - Phone:214-724-0702
Practice Address - Fax:214-245-5918
Is Sole Proprietor?:No
Enumeration Date:2013-09-13
Last Update Date:2016-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70989101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX70989OtherSTATE LIC #