Provider Demographics
NPI:1063496180
Name:VALENZUELA, JESUS ESPINOSA (LMSW/ACP, LMFT)
Entity Type:Individual
Prefix:MR
First Name:JESUS
Middle Name:ESPINOSA
Last Name:VALENZUELA
Suffix:
Gender:M
Credentials:LMSW/ACP, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 E YANDELL DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5714
Mailing Address - Country:US
Mailing Address - Phone:915-544-0772
Mailing Address - Fax:915-534-7887
Practice Address - Street 1:1725 E YANDELL DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5714
Practice Address - Country:US
Practice Address - Phone:915-544-0772
Practice Address - Fax:915-534-7887
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-01
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX097231041C0700X
NMI-11421041C0700X
TX265106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX128971203Medicaid
TX128971203Medicaid