Provider Demographics
NPI:1801410998
Name:VARGAS, ANESSA MARIE (LPC)
Entity Type:Individual
Prefix:
First Name:ANESSA
Middle Name:MARIE
Last Name:VARGAS
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 1:16607 BLANCO RD STE 1404
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-1945
Mailing Address - Country:US
Mailing Address - Phone:210-209-0642
Mailing Address - Fax:855-357-8282
Practice Address - Street 1:16607 BLANCO RD STE 1404
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-1945
Practice Address - Country:US
Practice Address - Phone:210-548-7757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-03
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX76663101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor