Provider Demographics
NPI:1013556059
Name:AGUERREVERE, LUIS EDUARDO (PHD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:EDUARDO
Last Name:AGUERREVERE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:LUIS
Other - Middle Name:EDUARDO
Other - Last Name:AGUERREVERE SUAREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1609 W FRANK AVE STE B
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3193
Mailing Address - Country:US
Mailing Address - Phone:936-272-0555
Mailing Address - Fax:936-272-0555
Practice Address - Street 1:1609 W FRANK AVE STE B
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3193
Practice Address - Country:US
Practice Address - Phone:936-272-0555
Practice Address - Fax:936-272-0555
Is Sole Proprietor?:No
Enumeration Date:2019-12-21
Last Update Date:2019-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX38332103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist