Provider Demographics
NPI:1215119177
Name:FLORES, JOHNNY (LPC)
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:
Last Name:FLORES
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 1:4014 N 22ND ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-4101
Mailing Address - Country:US
Mailing Address - Phone:956-507-0377
Mailing Address - Fax:956-992-1090
Practice Address - Street 1:355 W ELIZABETH ST STE 111B
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-5608
Practice Address - Country:US
Practice Address - Phone:956-572-3998
Practice Address - Fax:956-992-1090
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14499101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX027659405Medicaid