Provider Demographics
NPI:1396927570
Name:FLORES, LUIS JAIRO SR (MS/LLPC)
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:JAIRO
Last Name:FLORES
Suffix:SR
Gender:M
Credentials:MS/LLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 WATERMAN ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48209-2034
Mailing Address - Country:US
Mailing Address - Phone:734-260-0785
Mailing Address - Fax:
Practice Address - Street 1:79 W ALEXANDRINE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2015
Practice Address - Country:US
Practice Address - Phone:313-262-0957
Practice Address - Fax:313-831-4443
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401007832101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health