Provider Demographics
NPI:1053413559
Name:SANTIAGO, ATTALIE A (MA,LPC)
Entity type:Individual
Prefix:
First Name:ATTALIE
Middle Name:A
Last Name:SANTIAGO
Suffix:
Gender:F
Credentials:MA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W CENTRAL TEXAS EXPY
Mailing Address - Street 2:SUITE 208
Mailing Address - City:HARKER HEIGHTS
Mailing Address - State:TX
Mailing Address - Zip Code:76548-2079
Mailing Address - Country:US
Mailing Address - Phone:254-681-3842
Mailing Address - Fax:254-634-5222
Practice Address - Street 1:100 W CENTRAL TEXAS EXPY
Practice Address - Street 2:SUITE 208
Practice Address - City:HARKER HEIGHTS
Practice Address - State:TX
Practice Address - Zip Code:76548-2079
Practice Address - Country:US
Practice Address - Phone:254-681-3842
Practice Address - Fax:254-634-5222
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18944101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional