Provider Demographics
NPI:1053906735
Name:AYALA, CARLOS NARANJO JR (LCSW)
Entity type:Individual
Prefix:MR
First Name:CARLOS
Middle Name:NARANJO
Last Name:AYALA
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7220 N LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:SALADO
Mailing Address - State:TX
Mailing Address - Zip Code:76571-5325
Mailing Address - Country:US
Mailing Address - Phone:210-454-2589
Mailing Address - Fax:
Practice Address - Street 1:7220 N LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:SALADO
Practice Address - State:TX
Practice Address - Zip Code:76571-5325
Practice Address - Country:US
Practice Address - Phone:210-454-2589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-04
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TX6434451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health