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General NPI Number Information
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NPI Number | 1659771301
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Entity Type | Organization
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Legal Business Name | HOLY FAMILY PSYCHOTHERAPY TRAINING INSTITUTE, PLLC
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Dates
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Enumeration Date | 09/01/2014
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Last Update Date | 08/09/2024
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Provider Practice Location Address
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Address Line | 1414 N MEADOW AVE STE 1
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City | LAREDO
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State | TX
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Zip | 78040-8701
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Country | US
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Telephone | 956-744-5137
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Fax | 956-462-5003
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Provider Business Mailing Address
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Address Line | 3511 CUATRO VIENTOS DR
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City | LAREDO
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State | TX
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Zip | 78046-6946
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Country | US
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Telephone | 956-744-5137
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Fax | 956-462-5003
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Authorized Official
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Title or Position | OWNER/PSYCHOTHERAPIST
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Name | MR. JUAN GERARDO GALVAN-RODRIGUEZ
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Credential | LCSW
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Telephone | 956-744-5137
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 52925
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License Number State | TX
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