Provider Demographics
NPI:1255649687
Name:ARAGON, AGUSTIN M (LCDC)
Entity Type:Individual
Prefix:
First Name:AGUSTIN
Middle Name:M
Last Name:ARAGON
Suffix:
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3031 IH 10 W
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-5159
Mailing Address - Country:US
Mailing Address - Phone:210-731-1300
Mailing Address - Fax:210-731-1385
Practice Address - Street 1:3031 IH 10 W
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201-5159
Practice Address - Country:US
Practice Address - Phone:210-731-1300
Practice Address - Fax:210-731-1385
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11102101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)