Provider Demographics
NPI:1114537404
Name:ROBLES, VANESSA M (MS, LPC)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:M
Last Name:ROBLES
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8622 KEY SOUTH WAY
Mailing Address - Street 2:
Mailing Address - City:CONVERSE
Mailing Address - State:TX
Mailing Address - Zip Code:78109-3686
Mailing Address - Country:US
Mailing Address - Phone:210-382-2354
Mailing Address - Fax:
Practice Address - Street 1:8622 KEY SOUTH WAY
Practice Address - Street 2:
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-3686
Practice Address - Country:US
Practice Address - Phone:210-382-2354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66576101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty