Provider Demographics
NPI:1811194269
Name:DELEON, EDDIE JOE (LPC)
Entity Type:Individual
Prefix:
First Name:EDDIE
Middle Name:JOE
Last Name:DELEON
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 1:1751 IRIS DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-3904
Mailing Address - Country:US
Mailing Address - Phone:956-542-6036
Mailing Address - Fax:
Practice Address - Street 1:2039 PRICE
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521
Practice Address - Country:US
Practice Address - Phone:956-574-8253
Practice Address - Fax:956-574-8286
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX61731101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor