Provider Demographics
NPI:1689278855
Name:DELBOSQUE, JUAN FERNANDO (MS, LCDC)
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:FERNANDO
Last Name:DELBOSQUE
Suffix:
Gender:M
Credentials:MS, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1805 SHELY ST
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-4029
Mailing Address - Country:US
Mailing Address - Phone:361-232-6600
Mailing Address - Fax:
Practice Address - Street 1:1805 SHELY ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-4029
Practice Address - Country:US
Practice Address - Phone:361-232-6600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-28
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
7649101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)