Provider Demographics
NPI:1811465586
Name:VASQUEZ, ELIZABETH (LPC-INTERN)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:LPC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1403 SAN FRANCISCO ST
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-9673
Mailing Address - Country:US
Mailing Address - Phone:956-222-3367
Mailing Address - Fax:
Practice Address - Street 1:1403 SAN FRANCISCO ST
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-9673
Practice Address - Country:US
Practice Address - Phone:956-222-3367
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-11
Last Update Date:2018-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80049101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health