Provider Demographics
NPI:1114088978
Name:LERMA, JOE LUIS (PHD, LSSP, MS)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:LUIS
Last Name:LERMA
Suffix:
Gender:M
Credentials:PHD, LSSP, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 FLYNN PKWY
Mailing Address - Street 2:SUITE 310
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4318
Mailing Address - Country:US
Mailing Address - Phone:361-853-2600
Mailing Address - Fax:361-853-2611
Practice Address - Street 1:5151 FLYNN PKWY
Practice Address - Street 2:SUITE 310
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4318
Practice Address - Country:US
Practice Address - Phone:361-853-2600
Practice Address - Fax:361-853-2611
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22876103TC1900X
TX30424103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR57849Medicare UPIN
TX00G403Medicare ID - Type Unspecified