Provider Demographics
NPI:1215073390
Name:CONTRERAS, JUAN M (MA)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:M
Last Name:CONTRERAS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:705 NELSON PARK CIR
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-7672
Mailing Address - Country:US
Mailing Address - Phone:303-245-4419
Mailing Address - Fax:
Practice Address - Street 1:529 COFFMAN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-5450
Practice Address - Country:US
Practice Address - Phone:303-245-4419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health