Basic Information
| Provider Information | |||||||||
| NPI: | 1275923542 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ESCOBEDO | ||||||||
| FirstName: | ERNEST | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1100 W REYNOSA AVE | ||||||||
| Address2: | |||||||||
| City: | DE LEON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 764441630 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2548935895 | ||||||||
| FaxNumber: | 2548935222 | ||||||||
| Practice Location | |||||||||
| Address1: | 104 S PARK DR | ||||||||
| Address2: | |||||||||
| City: | BROWNWOOD | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3256460704 | ||||||||
| FaxNumber: | 8662476022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2015 | ||||||||
| LastUpdateDate: | 03/25/2019 | ||||||||
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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 | 101YP2500X | 73886 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.