Provider Demographics
NPI:1174275051
Name:SAUCEDA, RUBEN JR (LPC-A)
Entity Type:Individual
Prefix:
First Name:RUBEN
Middle Name:
Last Name:SAUCEDA
Suffix:JR
Gender:M
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 ELIZABETH ST APT 430
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2090
Mailing Address - Country:US
Mailing Address - Phone:212-786-2003
Mailing Address - Fax:
Practice Address - Street 1:3300 OAK LAWN AVE STE 601
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-4439
Practice Address - Country:US
Practice Address - Phone:212-786-2003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-22
Last Update Date:2022-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health