Provider Demographics
NPI:1386855252
Name:VEGA, OMAR A (LPCC, LED, LSP)
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:A
Last Name:VEGA
Suffix:
Gender:M
Credentials:LPCC, LED, LSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 RITO GUICU
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-4321
Mailing Address - Country:US
Mailing Address - Phone:505-235-4002
Mailing Address - Fax:505-473-9409
Practice Address - Street 1:29 RITO GUICU
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-4321
Practice Address - Country:US
Practice Address - Phone:505-235-4002
Practice Address - Fax:505-473-9409
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM375345103TS0200X
NM0123991101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM64972526Medicaid