Provider Demographics
NPI:1053606640
Name:HINOJOZA SANTACRUZ, CLELIA M
Entity type:Individual
Prefix:MRS
First Name:CLELIA
Middle Name:M
Last Name:HINOJOZA SANTACRUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:CLELIA
Other - Middle Name:M
Other - Last Name:HINOJOZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW-IPR
Mailing Address - Street 1:901 BRIAR RIDGE DRIVE
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:901 BRIAR RIDGE DR
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-3868
Practice Address - Country:US
Practice Address - Phone:817-905-9618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-13
Last Update Date:2011-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25988104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker