Provider Demographics
NPI:1255935672
Name:TIRADO, JOSE (LPC/LMHC)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:
Last Name:TIRADO
Suffix:
Gender:M
Credentials:LPC/LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LAGOS DEL NORTE
Mailing Address - Street 2:APARMENT 1607
Mailing Address - City:TOA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00949
Mailing Address - Country:US
Mailing Address - Phone:787-630-0995
Mailing Address - Fax:
Practice Address - Street 1:LAGOS DEL NORTE
Practice Address - Street 2:APT. 1607
Practice Address - City:TOA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00949
Practice Address - Country:US
Practice Address - Phone:787-630-0995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4022101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health