Provider Demographics
NPI:1003402090
Name:NAVARRO, IVAN CAMILO (LPC)
Entity Type:Individual
Prefix:MR
First Name:IVAN
Middle Name:CAMILO
Last Name:NAVARRO
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3318 MEMORIAL CREST BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-8313
Mailing Address - Country:US
Mailing Address - Phone:832-513-5695
Mailing Address - Fax:
Practice Address - Street 1:3318 MEMORIAL CREST BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-8313
Practice Address - Country:US
Practice Address - Phone:832-513-5695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78095101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health