Basic Information
| Provider Information | |||||||||
| NPI: | 1639727100 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | INTERIANO | ||||||||
| FirstName: | ALVARO | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.ED, LPC-INTERN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8703 MEADOWCROFT DR | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770635006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138407956 | ||||||||
| FaxNumber: | 7138407957 | ||||||||
| Practice Location | |||||||||
| Address1: | 8703 MEADOWCROFT DR | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770635006 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7138407956 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2019 | ||||||||
| LastUpdateDate: | 09/09/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 79431 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 1689945966 | 01 | TX | BENJAMINS BEHAVIORAL HEALTHCARE | OTHER |