Provider Demographics
NPI:1780232223
Name:AQUINO, AHMED GAMAL (LPC)
Entity Type:Individual
Prefix:MR
First Name:AHMED
Middle Name:GAMAL
Last Name:AQUINO
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:MR
Other - First Name:AHMED
Other - Middle Name:GAMAL
Other - Last Name:AQUINO CAZAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-2111
Mailing Address - Fax:
Practice Address - Street 1:1901 SW H K DODGEN LOOP
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1814
Practice Address - Country:US
Practice Address - Phone:254-935-5094
Practice Address - Fax:254-935-5099
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-28
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78437101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty