Provider Demographics
NPI:1700910742
Name:CONTRERAS, JUAN CARLOS (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUAN
Middle Name:CARLOS
Last Name:CONTRERAS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 MONTANA AVE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-5578
Mailing Address - Country:US
Mailing Address - Phone:915-525-3425
Mailing Address - Fax:915-209-3077
Practice Address - Street 1:1310 MONTANA AVE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-5578
Practice Address - Country:US
Practice Address - Phone:915-525-3425
Practice Address - Fax:915-209-3077
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2022-0136103T00000X
TX37928103TC0700X
CAPSY23433103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist