Healthcare Provider Details

I. General information

NPI: 1033770367
Provider Name (Legal Business Name): JUAN ANTONIO LOERA GONZALEZ LPCC 16813
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2019
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 W HENDERSON AVE STE 2
PORTERVILLE CA
93257-1490
US

IV. Provider business mailing address

1768 CLEARWATER ST
TULARE CA
93274-7472
US

V. Phone/Fax

Practice location:
  • Phone: 559-788-1200
  • Fax: 559-713-3717
Mailing address:
  • Phone: 559-202-6189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6611
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6611
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number16813
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: