Provider Demographics
NPI:1144637406
Name:ALVAREZ, JUAN YGNACIO (MSW)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:YGNACIO
Last Name:ALVAREZ
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5656 GASMER DR.
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035
Mailing Address - Country:US
Mailing Address - Phone:713-422-2650
Mailing Address - Fax:
Practice Address - Street 1:1003 ISLAND VIEW ST
Practice Address - Street 2:
Practice Address - City:KEMAH
Practice Address - State:TX
Practice Address - Zip Code:77565-2168
Practice Address - Country:US
Practice Address - Phone:281-334-4389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3122101YA0400X
TX170881041C0700X, 273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3122OtherCD COUNSELOR