Provider Demographics
NPI:1801070016
Name:CAMPOS, LETICIA ARELY (LMSW)
Entity type:Individual
Prefix:MRS
First Name:LETICIA
Middle Name:ARELY
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:LETICIA
Other - Middle Name:ARELY
Other - Last Name:MERLA-CAMPOS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:PO BOX 761884
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-6884
Mailing Address - Country:US
Mailing Address - Phone:210-764-5540
Mailing Address - Fax:210-764-5541
Practice Address - Street 1:1015 FERDINAND DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-1364
Practice Address - Country:US
Practice Address - Phone:210-764-5540
Practice Address - Fax:210-764-5541
Is Sole Proprietor?:No
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38386171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator