Provider Demographics
NPI:1841540424
Name:TORRES, JOSE G (LCDC)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:G
Last Name:TORRES
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1140 SUNNYSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75211-6237
Mailing Address - Country:US
Mailing Address - Phone:972-850-8069
Mailing Address - Fax:
Practice Address - Street 1:1005 W JEFFERSON BLVD
Practice Address - Street 2:SUIT 205
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75208-5087
Practice Address - Country:US
Practice Address - Phone:972-850-8069
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-11
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11151101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)