Provider Demographics
NPI:1962194753
Name:AGUIRRE, VANESSA (LPC-A)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:AGUIRRE
Suffix:
Gender:F
Credentials:LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 TALLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-8318
Mailing Address - Country:US
Mailing Address - Phone:512-876-3158
Mailing Address - Fax:
Practice Address - Street 1:3007 DAWN DR STE 102
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-2864
Practice Address - Country:US
Practice Address - Phone:512-876-3158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX91660101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional