GINO MATA

AZLE, TX
NPI1417736521
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: TX  CI)
Enumeration Date2023-09-27
Last Update Date2023-09-27
Business Address
GINO MATA LCDC-Intern
7510 FM 1886
AZLE, TX 76020-1054
Phone number: 817-448-8893
Mailing Address
GINO MATA LCDC-Intern
7510 FM 1886
AZLE, TX 76020-1054
Phone number:
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