Provider Demographics
NPI:1154457729
Name:VILLARREAL, JOHN GILBERT (MA)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:GILBERT
Last Name:VILLARREAL
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7025 COPPER MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78413-4307
Mailing Address - Country:US
Mailing Address - Phone:361-850-9708
Mailing Address - Fax:361-850-9708
Practice Address - Street 1:7025 COPPER MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-4307
Practice Address - Country:US
Practice Address - Phone:361-850-9708
Practice Address - Fax:361-850-9708
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6045103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool