Provider Demographics
NPI:1104664291
Name:PUENTE, JUAN FRANCISCO JR
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:FRANCISCO
Last Name:PUENTE
Suffix:JR
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 1:6506 SAINT JUDE DR
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-5449
Mailing Address - Country:US
Mailing Address - Phone:832-620-6873
Mailing Address - Fax:
Practice Address - Street 1:6506 SAINT JUDE DR
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-5449
Practice Address - Country:US
Practice Address - Phone:832-620-6873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90328101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional