Provider Demographics
NPI:1467293639
Name:TORRES RIVERA, JAIME MIGUEL
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:MIGUEL
Last Name:TORRES RIVERA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6703 MODESTO RD
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-5873
Mailing Address - Country:US
Mailing Address - Phone:254-432-3673
Mailing Address - Fax:
Practice Address - Street 1:6703 MODESTO RD
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-5873
Practice Address - Country:US
Practice Address - Phone:254-432-3673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-03
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX94045101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health