Individual
JAVIER CARRILLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
3115 SOUTH LOOP 306, SUITE 110, SAN ANGELO, TX 76904-5983
(325) 942-1952
(325) 942-1517
Mailing address
8900 VISCOUNT BLVD STE AN117, EL PASO, TX 79925-5897
(915) 491-0707
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
24690
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
117826108
—
TX
01
—
87709A
BCBS
TX
Enumeration date
06/21/2006
Last updated
11/13/2020
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