Provider Demographics
NPI:1588196703
Name:BARBOSA, JAIME (MA, LPC)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:BARBOSA
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 MILDRED ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-3410
Mailing Address - Country:US
Mailing Address - Phone:956-243-0423
Mailing Address - Fax:
Practice Address - Street 1:104 MILDRED ST
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-3410
Practice Address - Country:US
Practice Address - Phone:956-243-0423
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-28
Last Update Date:2017-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74264101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional