Basic Information
| Provider Information | |||||||||
| NPI: | 1073721924 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CERVANTES | ||||||||
| FirstName: | NEFTALI | ||||||||
| MiddleName: | MARTINEZ | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW, LCDC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9700 BISSONNET ST STE 1000W | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770368001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8327331100 | ||||||||
| FaxNumber: | 8328259461 | ||||||||
| Practice Location | |||||||||
| Address1: | 9700 BISSONNET ST STE 1000W | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770368001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8327331100 | ||||||||
| FaxNumber: | 8328259461 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/21/2007 | ||||||||
| LastUpdateDate: | 11/13/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 54495 | TX | N | Behavioral Health & Social Service Providers | Social Worker | 101YA0400X | 9454 | TX | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 1041C0700X | 54495 | TX | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.