Provider Demographics
NPI:1003208174
Name:VASQUEZ, KACEY (MS)
Entity Type:Individual
Prefix:
First Name:KACEY
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 BUFFALO GAP RD
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-2723
Mailing Address - Country:US
Mailing Address - Phone:972-460-6864
Mailing Address - Fax:
Practice Address - Street 1:3010 LEGACY DR STE 220
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-7339
Practice Address - Country:US
Practice Address - Phone:214-618-8402
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-26
Last Update Date:2023-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71049101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor