Provider Demographics
NPI:1689736373
Name:VASQUEZ, MICHELLE E (LPC)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:E
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 792115
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78279-2115
Mailing Address - Country:US
Mailing Address - Phone:210-663-9462
Mailing Address - Fax:210-826-8903
Practice Address - Street 1:8107 BROADWAY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-1956
Practice Address - Country:US
Practice Address - Phone:210-663-9462
Practice Address - Fax:210-826-8903
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14360101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional