Provider Demographics
NPI:1235016155
Name:VASQUEZ, JACOB ISAAC (LCDC LPC-A)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:ISAAC
Last Name:VASQUEZ
Suffix:
Gender:M
Credentials:LCDC LPC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5118 COOS BAY
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-1963
Mailing Address - Country:US
Mailing Address - Phone:956-334-9366
Mailing Address - Fax:956-334-9366
Practice Address - Street 1:5219 MCPHERSON RD
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-7306
Practice Address - Country:US
Practice Address - Phone:956-334-9366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90095101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health