Provider Demographics
NPI:1386384659
Name:IBARRA, JULIO ALBERTO (LPC)
Entity type:Individual
Prefix:
First Name:JULIO
Middle Name:ALBERTO
Last Name:IBARRA
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:JULIO
Other - Middle Name:ALBERTO
Other - Last Name:IBARRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC
Mailing Address - Street 1:2190 JOHNSON ST
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-3790
Mailing Address - Country:US
Mailing Address - Phone:956-543-7331
Mailing Address - Fax:
Practice Address - Street 1:2190 JOHNSON ST
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-3790
Practice Address - Country:US
Practice Address - Phone:956-543-7331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX82597101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health