Provider Demographics
NPI:1225145352
Name:VASQUEZ, RODOLFO ENRIQUE (LPC)
Entity Type:Individual
Prefix:
First Name:RODOLFO
Middle Name:ENRIQUE
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5959 GATEWAY WEST
Mailing Address - Street 2:SUITE 501
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79925
Mailing Address - Country:US
Mailing Address - Phone:915-491-5715
Mailing Address - Fax:
Practice Address - Street 1:5959 GATEWAY WEST
Practice Address - Street 2:SUITE 501
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79925
Practice Address - Country:US
Practice Address - Phone:915-772-1829
Practice Address - Fax:915-772-5133
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17942101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional