Provider Demographics
NPI:1417284209
Name:VARGAS, PATRICK (MA, LPC)
Entity Type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:
Last Name:VARGAS
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 S MAIN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78204-1128
Mailing Address - Country:US
Mailing Address - Phone:210-822-9493
Mailing Address - Fax:210-822-8733
Practice Address - Street 1:410 S MAIN
Practice Address - Street 2:SUITE 201
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78204-1128
Practice Address - Country:US
Practice Address - Phone:210-822-9493
Practice Address - Fax:210-822-8733
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-16
Last Update Date:2019-06-20
Deactivation Date:2016-09-29
Deactivation Code:
Reactivation Date:2019-06-20
Provider Licenses
StateLicense IDTaxonomies
TX58749101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional