Provider Demographics
NPI:1326823402
Name:VILLALOBOS, JUAN PABLO SR (PSS,CRM,CADC-R)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:PABLO
Last Name:VILLALOBOS
Suffix:SR
Gender:M
Credentials:PSS,CRM,CADC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:398 NW 183RD AVE # 398
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97006-3410
Mailing Address - Country:US
Mailing Address - Phone:971-222-6155
Mailing Address - Fax:
Practice Address - Street 1:398 NW 183RD AVE # 398
Practice Address - Street 2:
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97006-3410
Practice Address - Country:US
Practice Address - Phone:971-222-6155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORT-23-2785101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)