Basic Information
| Provider Information | |||||||||
| NPI: | 1376036400 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VIAFARA | ||||||||
| FirstName: | FREDDY | ||||||||
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| Credential: | LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1515 HYDE PARK BLVD UNIT 6 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770062539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7134786052 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3730 KIRBY DR STE 904 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770983994 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8324842635 | ||||||||
| FaxNumber: | 8322022479 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2018 | ||||||||
| LastUpdateDate: | 06/13/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 73589 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.