Provider Demographics
NPI:1235672601
Name:VASQUEZ, BETSY (MAMHC, LPC)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:MAMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22155 WILDWOOD PARK RD
Mailing Address - Street 2:APT. 533
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77469-5200
Mailing Address - Country:US
Mailing Address - Phone:917-715-5126
Mailing Address - Fax:
Practice Address - Street 1:1415 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006-2602
Practice Address - Country:US
Practice Address - Phone:832-548-5100
Practice Address - Fax:832-548-5092
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX74647101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional