Provider Demographics
NPI:1528390036
Name:REYNA DE VASQUEZ, PRISCILLA (PHD, LPC-S, RPT-S)
Entity Type:Individual
Prefix:DR
First Name:PRISCILLA
Middle Name:
Last Name:REYNA DE VASQUEZ
Suffix:
Gender:F
Credentials:PHD, LPC-S, RPT-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94 COVENEY TRL
Mailing Address - Street 2:
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-8244
Mailing Address - Country:US
Mailing Address - Phone:210-569-2961
Mailing Address - Fax:
Practice Address - Street 1:9518 TIOGA DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-3118
Practice Address - Country:US
Practice Address - Phone:210-495-4888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2020-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64028101Y00000X, 101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health