Provider Demographics
NPI:1679105829
Name:BALLESTEROS, NUBIA KAREN (MS, LPC)
Entity type:Individual
Prefix:
First Name:NUBIA
Middle Name:KAREN
Last Name:BALLESTEROS
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 SOUTHLOOP DR
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-2339
Mailing Address - Country:US
Mailing Address - Phone:214-777-2419
Mailing Address - Fax:
Practice Address - Street 1:827 SOUTHLOOP DR
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75137-2339
Practice Address - Country:US
Practice Address - Phone:214-777-2419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-05
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78340101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty