Provider Demographics
NPI:1811588114
Name:FLORES, AGUSTA JEAN (LPC-ASSOCIATE, LCDC)
Entity Type:Individual
Prefix:MS
First Name:AGUSTA
Middle Name:JEAN
Last Name:FLORES
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 OAK VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:LAKEHILLS
Mailing Address - State:TX
Mailing Address - Zip Code:78063-6248
Mailing Address - Country:US
Mailing Address - Phone:210-717-0986
Mailing Address - Fax:
Practice Address - Street 1:519 E QUINCY ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78215-1605
Practice Address - Country:US
Practice Address - Phone:210-299-1614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-29
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15461101YA0400X
TX91018101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)