Provider Demographics
NPI:1720322019
Name:CONTRERAS, MICHAEL CHRISTOPHER (LPC-S, LCDC)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CHRISTOPHER
Last Name:CONTRERAS
Suffix:
Gender:M
Credentials:LPC-S, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8328 EDGEPOINT TRL
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-7447
Mailing Address - Country:US
Mailing Address - Phone:817-875-5845
Mailing Address - Fax:
Practice Address - Street 1:2217 MARTIN DR STE 200
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-6249
Practice Address - Country:US
Practice Address - Phone:817-537-2044
Practice Address - Fax:844-318-2753
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-27
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67235101YP2500X
TX13526101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX312929803Medicaid
TX3129298 01Medicaid
TX312929801Medicaid