Provider Demographics
NPI:1093972135
Name:OTERO, JOSEPH L (LCDC)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:L
Last Name:OTERO
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 BOEING DR STE L150
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925-1156
Mailing Address - Country:US
Mailing Address - Phone:915-779-5600
Mailing Address - Fax:915-779-5605
Practice Address - Street 1:6500 BOEING DR STE L150
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925-1156
Practice Address - Country:US
Practice Address - Phone:915-779-5600
Practice Address - Fax:915-779-5605
Is Sole Proprietor?:No
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9377101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMVNM30451NIMedicaid