Provider Demographics
NPI:1083270599
Name:VASILEVA, GINKA V (LMFT)
Entity Type:Individual
Prefix:
First Name:GINKA
Middle Name:V
Last Name:VASILEVA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:GUINKA
Other - Middle Name:V
Other - Last Name:VASILEVA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LMFT
Mailing Address - Street 1:29827 S LEGENDS VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-2039
Mailing Address - Country:US
Mailing Address - Phone:713-992-5791
Mailing Address - Fax:
Practice Address - Street 1:256 ED ENGLISH DR STE C
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77385-8028
Practice Address - Country:US
Practice Address - Phone:713-992-5791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-10
Last Update Date:2022-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203331106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX203331OtherTEXAS STATE BOARD OF EXAMINERS OF MARRIAGE AND FAMILY THERAPISTS