Provider Demographics
NPI:1679630933
Name:PACHECO, JOHN RODRIGUEZ (LPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:RODRIGUEZ
Last Name:PACHECO
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 LOWRY RD
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-7051
Mailing Address - Country:US
Mailing Address - Phone:956-236-1405
Mailing Address - Fax:956-723-4770
Practice Address - Street 1:1319 CORPUS CHRISTI ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-5356
Practice Address - Country:US
Practice Address - Phone:956-236-1405
Practice Address - Fax:956-723-4770
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14888101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6599LCOtherBLUE CROSS BLUE SHIELD