Provider Demographics
NPI:1801214168
Name:STEVEN VAZQUEZ PH D PC
Entity type:Organization
Organization Name:STEVEN VAZQUEZ PH D PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:817-268-7050
Mailing Address - Street 1:2520 HARWOOD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEDFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76021-6709
Mailing Address - Country:US
Mailing Address - Phone:817-268-7050
Mailing Address - Fax:
Practice Address - Street 1:2520 HARWOOD RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BEDFORD
Practice Address - State:TX
Practice Address - Zip Code:76021-6709
Practice Address - Country:US
Practice Address - Phone:817-268-7050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-03
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6477101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty