Provider Demographics
NPI:1619415247
Name:NAVARRO, JUAN CARLOS (LPCC 6557)
Entity Type:Individual
Prefix:
First Name:JUAN CARLOS
Middle Name:
Last Name:NAVARRO
Suffix:
Gender:M
Credentials:LPCC 6557
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 E VIRGINIA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-5865
Mailing Address - Country:US
Mailing Address - Phone:408-387-6200
Mailing Address - Fax:408-998-1535
Practice Address - Street 1:160 E VIRGINIA ST
Practice Address - Street 2:STE. 100
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-5857
Practice Address - Country:US
Practice Address - Phone:408-579-6178
Practice Address - Fax:408-579-6143
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-02
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIN PROCESS101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health