Healthcare Provider Details

I. General information

NPI: 1619415247
Provider Name (Legal Business Name): JUAN CARLOS NAVARRO LPCC 6557
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2017
Last Update Date: 08/14/2024
Certification Date: 08/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E VIRGINIA ST STE. 100
SAN JOSE CA
95112-5857
US

IV. Provider business mailing address

160 E VIRGINIA ST STE 100
SAN JOSE CA
95112-5865
US

V. Phone/Fax

Practice location:
  • Phone: 408-579-6178
  • Fax: 408-579-6143
Mailing address:
  • Phone: 408-387-6200
  • Fax: 408-998-1535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6557
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: