Provider Demographics
NPI:1679657282
Name:LE PERE, DOROTHY W (LCSW LMFT CGP)
Entity type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:W
Last Name:LE PERE
Suffix:
Gender:F
Credentials:LCSW LMFT CGP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1635 NE LOOP 410
Mailing Address - Street 2:STE 501
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209
Mailing Address - Country:US
Mailing Address - Phone:210-821-5980
Mailing Address - Fax:210-821-6121
Practice Address - Street 1:1635 NE LOOP 410
Practice Address - Street 2:STE 501
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209
Practice Address - Country:US
Practice Address - Phone:210-821-5980
Practice Address - Fax:210-821-6121
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS05728104100000X
TX3858106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX070948701Medicaid
TX070948701Medicaid