Provider Demographics
NPI:1356701106
Name:CORTEZ, JOAN LEE (MS)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:LEE
Last Name:CORTEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:LEE
Other - Last Name:PULLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3131 MEDINA HWY
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-9868
Mailing Address - Country:US
Mailing Address - Phone:830-285-4931
Mailing Address - Fax:
Practice Address - Street 1:500 THOMPSON DR
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5144
Practice Address - Country:US
Practice Address - Phone:830-257-6553
Practice Address - Fax:830-896-4448
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-07
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX70764101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional