Provider Demographics
NPI:1114436813
Name:SERNA, TERESA VASQUEZ (LPC)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:VASQUEZ
Last Name:SERNA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7308 GEORGE BURNS ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-2325
Mailing Address - Country:US
Mailing Address - Phone:210-789-4605
Mailing Address - Fax:
Practice Address - Street 1:4813 FREDERICKSBURG RD STE 102B
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3666
Practice Address - Country:US
Practice Address - Phone:210-789-4605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-25
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71879101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional