Provider Demographics
NPI:1497988489
Name:VILLARREAL, CARLO A (PHD)
Entity Type:Individual
Prefix:
First Name:CARLO
Middle Name:A
Last Name:VILLARREAL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 BOLSOVER ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77005-2590
Mailing Address - Country:US
Mailing Address - Phone:713-986-3300
Mailing Address - Fax:713-986-3553
Practice Address - Street 1:2500 BOLSOVER ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-2590
Practice Address - Country:US
Practice Address - Phone:713-986-3300
Practice Address - Fax:713-986-3553
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX34069103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical