Provider Demographics
NPI:1659771301
Name:HOLY FAMILY PSYCHOTHERAPY TRAINING INSTITUTE, PLLC
Entity Type:Organization
Organization Name:HOLY FAMILY PSYCHOTHERAPY TRAINING INSTITUTE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHOTHERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JUAN
Authorized Official - Middle Name:GERARDO
Authorized Official - Last Name:GALVAN-RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:956-744-5137
Mailing Address - Street 1:3511 CUATRO VIENTOS DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78046-6946
Mailing Address - Country:US
Mailing Address - Phone:956-744-5137
Mailing Address - Fax:956-462-5003
Practice Address - Street 1:1414 N MEADOW AVE STE 1
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-8701
Practice Address - Country:US
Practice Address - Phone:956-744-5137
Practice Address - Fax:956-462-5003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-01
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX529251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2147266-03Medicaid
TX2147266-02Medicaid
TXTXB157421OtherMEDICARE PTA