Provider Demographics
NPI:1730230178
Name:ALVAREZ, SANDRA ANA (MS,LBSW,LPC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:ANA
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:MS,LBSW,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 4185
Mailing Address - Street 2:129 CIRCLE WAY, SUITE 108
Mailing Address - City:LAKE JACKSON
Mailing Address - State:TX
Mailing Address - Zip Code:77566-2085
Mailing Address - Country:US
Mailing Address - Phone:979-487-9300
Mailing Address - Fax:
Practice Address - Street 1:129 CIRCLE WAY ST STE 108
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5239
Practice Address - Country:US
Practice Address - Phone:979-487-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-14
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLPC 13546101YP2500X
TXLBSW 26395101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0957193-02Medicaid