Provider Demographics
NPI:1699813618
Name:CONTRERAS, JOSE ANTONIO SR (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:ANTONIO
Last Name:CONTRERAS
Suffix:SR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2307 WEST HARRIS
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901
Mailing Address - Country:US
Mailing Address - Phone:325-947-7729
Mailing Address - Fax:325-947-9755
Practice Address - Street 1:2307 WEST HARRIS
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901
Practice Address - Country:US
Practice Address - Phone:325-947-7729
Practice Address - Fax:325-947-9755
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX551106H00000X, 106H00000X
TX469101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist