Provider Demographics
NPI:1669284469
Name:VASQUEZ, ANGEL (LPC-ASSOCIATE)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 E TWOHIG AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903-6433
Mailing Address - Country:US
Mailing Address - Phone:325-944-2561
Mailing Address - Fax:
Practice Address - Street 1:36 E TWOHIG AVE
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903-6433
Practice Address - Country:US
Practice Address - Phone:325-944-2561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-21
Last Update Date:2025-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX93570101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor