Provider Demographics
NPI:1992105829
Name:VALENZUELA, JOSE LUIS (LPC, LCDC)
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:LUIS
Last Name:VALENZUELA
Suffix:
Gender:M
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6304 HUTSELL PL
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79932-1874
Mailing Address - Country:US
Mailing Address - Phone:915-540-2559
Mailing Address - Fax:
Practice Address - Street 1:6304 HUTSELL PL
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79932-1874
Practice Address - Country:US
Practice Address - Phone:915-540-2559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-28
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
TX66821101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)