Provider Demographics
NPI:1629355953
Name:AGUIRRE, RUBEN M SR (PSYD, LPC-S, LCDC)
Entity Type:Individual
Prefix:DR
First Name:RUBEN
Middle Name:M
Last Name:AGUIRRE
Suffix:SR
Gender:M
Credentials:PSYD, LPC-S, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 N CYPRESS AVE
Mailing Address - Street 2:
Mailing Address - City:STEPHENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76401-2243
Mailing Address - Country:US
Mailing Address - Phone:254-413-5455
Mailing Address - Fax:
Practice Address - Street 1:1201 W PEARL ST APT B9
Practice Address - Street 2:
Practice Address - City:GRANBURY
Practice Address - State:TX
Practice Address - Zip Code:76048-1841
Practice Address - Country:US
Practice Address - Phone:972-765-1115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20150101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional