Basic Information
| Provider Information | |||||||||
| NPI: | 1154496073 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CARRANZA | ||||||||
| FirstName: | HENRY | ||||||||
| MiddleName: | SANTOS | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1515 PAPPAS ST. | ||||||||
| Address2: | |||||||||
| City: | LAREDO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78041 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9567958100 | ||||||||
| FaxNumber: | 9567958147 | ||||||||
| Practice Location | |||||||||
| Address1: | 1515 PAPPAS ST. | ||||||||
| Address2: | |||||||||
| City: | LAREDO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780411705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9567958100 | ||||||||
| FaxNumber: | 9567958147 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | 6426 | TX | Y | Behavioral Health & Social Service Providers | Counselor |
ID Information
| ID | Type | State | Issuer | Description | 6426 | 01 | TX | TEXAS STATE BOARD | OTHER |