Healthcare Provider Details

I. General information

NPI: 1518059633
Provider Name (Legal Business Name): ROBERTO JESUS JUAREZ LMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5302 RUSTIC MNR
BROWNSVILLE TX
78526-3901
US

IV. Provider business mailing address

5302 RUSTIC MNR
BROWNSVILLE TX
78526-3901
US

V. Phone/Fax

Practice location:
  • Phone: 956-592-7985
  • Fax:
Mailing address:
  • Phone: 956-592-7985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4603
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: