Provider Demographics
NPI:1396003026
Name:VILLARREAL, EDGAR JAVIER (PHD)
Entity type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:JAVIER
Last Name:VILLARREAL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 S PARKER RD STE 114
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-2119
Mailing Address - Country:US
Mailing Address - Phone:956-324-9335
Mailing Address - Fax:
Practice Address - Street 1:1230 S PARKER RD STE 114
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-2119
Practice Address - Country:US
Practice Address - Phone:956-324-9335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2025-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001339103T00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX390200000XOtherSTUDENT IN AN ORGANIZED HEALTHCARE EDUCATION/TRAINING PROGRAM