MEDICARE: JUAN JAVIER FLORES JR. LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	66169	TX

General Provider Information

NPI Number	:	1942787973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUAN JAVIER FLORES JR. LCSW

Provider Business Mailing Address
First Line	:	10201 BUFFALO SPEEDWAY APT 3125
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77054-2548
Country	:	US
Telephone Number	:	832-484-8044
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 MAIN ST
Second Line	:
City	:	SOUTH HOUSTON
State	:	TX
Zip	:	77587-4252
Country	:	US
Telephone Number	:	713-946-7461
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2018
Last Update Date	:	02/17/2022

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