Basic Information
| Provider Information | |||||||||
| NPI: | 1235248493 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CUEVAS | ||||||||
| FirstName: | NYDIA | ||||||||
| MiddleName: | CASARES | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | LPC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CASARES | ||||||||
| OtherFirstName: | NYDIA | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 7011 SOUTHWEST FWY | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770742007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139707000 | ||||||||
| FaxNumber: | 7139707246 | ||||||||
| Practice Location | |||||||||
| Address1: | 7011 SOUTHWEST FWY | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770742007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139707000 | ||||||||
| FaxNumber: | 7139707246 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 05/14/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | N | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YP2500X | N | Behavioral Health & Social Service Providers | Counselor | Professional |
ID Information
| ID | Type | State | Issuer | Description | 178113005 | 05 | TX | MEDICAID |