Provider Demographics
NPI:1215375787
Name:LUMBRERAS, JUAN (LPC)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:LUMBRERAS
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 W ZAVALA ST STE B
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL CITY
Mailing Address - State:TX
Mailing Address - Zip Code:78839-3241
Mailing Address - Country:US
Mailing Address - Phone:830-775-5100
Mailing Address - Fax:830-775-5188
Practice Address - Street 1:702 SAN PEDRO AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4610
Practice Address - Country:US
Practice Address - Phone:210-299-2406
Practice Address - Fax:210-270-0545
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX68161101YP2500X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX322023802Medicaid