Provider Demographics
NPI:1548464548
Name:BERUMEN, JOHN JR (LMFT)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:BERUMEN
Suffix:JR
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 WEATHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-2361
Mailing Address - Country:US
Mailing Address - Phone:956-568-0076
Mailing Address - Fax:
Practice Address - Street 1:2801 FREMONT ST
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-2723
Practice Address - Country:US
Practice Address - Phone:956-722-0121
Practice Address - Fax:956-722-1916
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4693106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist