Provider Demographics
NPI:1699040642
Name:VALDEZ, PABLO JR (MA LPC)
Entity Type:Individual
Prefix:
First Name:PABLO
Middle Name:
Last Name:VALDEZ
Suffix:JR
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 1:5839 RUE BURGUNDY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-2342
Mailing Address - Country:US
Mailing Address - Phone:210-421-2835
Mailing Address - Fax:
Practice Address - Street 1:5839 RUE BURGUNDY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-2342
Practice Address - Country:US
Practice Address - Phone:210-421-2835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-08
Last Update Date:2012-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX44690101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional