Provider Demographics
NPI:1174654735
Name:VASQUEZ, MELBA J (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELBA
Middle Name:J
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2901 BEE CAVE RD
Mailing Address - Street 2:BOX N
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5584
Mailing Address - Country:US
Mailing Address - Phone:512-329-8000
Mailing Address - Fax:512-329-8299
Practice Address - Street 1:2901 BEE CAVE RD
Practice Address - Street 2:BOX N
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5584
Practice Address - Country:US
Practice Address - Phone:512-329-8000
Practice Address - Fax:512-329-8299
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22529103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00G70YMedicare ID - Type Unspecified