Provider Demographics
NPI:1295741874
Name:VILLARREAL, MELCHOR D (LCSW)
Entity type:Individual
Prefix:
First Name:MELCHOR
Middle Name:D
Last Name:VILLARREAL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 BRIGGS ST STE 700
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78224-1272
Mailing Address - Country:US
Mailing Address - Phone:210-924-3556
Mailing Address - Fax:210-924-3557
Practice Address - Street 1:94 BRIGGS ST STE 700
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78224-1272
Practice Address - Country:US
Practice Address - Phone:210-924-3556
Practice Address - Fax:210-924-3557
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS083591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX040648005Medicaid
TX040648005Medicaid