Provider Demographics
NPI:1124653563
Name:TOVAR, CRISTIAN OBED (LPC)
Entity type:Individual
Prefix:
First Name:CRISTIAN
Middle Name:OBED
Last Name:TOVAR
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 61226
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78466-1226
Mailing Address - Country:US
Mailing Address - Phone:361-442-4024
Mailing Address - Fax:361-853-7877
Practice Address - Street 1:4639 CORONA DR STE 34
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-5430
Practice Address - Country:US
Practice Address - Phone:361-442-4024
Practice Address - Fax:361-806-9491
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78953101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty