Provider Demographics
NPI:1922541762
Name:BARAJAS, AGUSTIN (CRC, LPC-INTERN)
Entity Type:Individual
Prefix:
First Name:AGUSTIN
Middle Name:
Last Name:BARAJAS
Suffix:
Gender:M
Credentials:CRC, LPC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7804 SANTA MONICA CT
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79915-2110
Mailing Address - Country:US
Mailing Address - Phone:915-317-0785
Mailing Address - Fax:
Practice Address - Street 1:7804 SANTA MONICA CT
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79915-2110
Practice Address - Country:US
Practice Address - Phone:915-317-0785
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX00174746101Y00000X, 225C00000X
TX76800101Y00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health