Provider Demographics
NPI:1326601923
Name:GARIBAY VAZQUEZ, ESPERANZA IVONNE (MA, LMHC, LPC)
Entity Type:Individual
Prefix:
First Name:ESPERANZA
Middle Name:IVONNE
Last Name:GARIBAY VAZQUEZ
Suffix:
Gender:F
Credentials:MA, LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2149 SHY BEAR WAY NW APT 304
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98027-5628
Mailing Address - Country:US
Mailing Address - Phone:503-765-2759
Mailing Address - Fax:
Practice Address - Street 1:2149 SHY BEAR WAY NW APT 304
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-5628
Practice Address - Country:US
Practice Address - Phone:503-765-2759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-18
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60593133101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health