Basic Information
| Provider Information | |||||||||
| NPI: | 1821682170 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CERDA | ||||||||
| FirstName: | MARI-LUCI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2824 25TH ST | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794102216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9793234352 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1614 AVENUE M STE 42 | ||||||||
| Address2: | |||||||||
| City: | LUBBOCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 794014952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8558326727 | ||||||||
| FaxNumber: | 7726759100 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2021 | ||||||||
| LastUpdateDate: | 10/14/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/14/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 11937973 | TX | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.