Provider Demographics
NPI:1538583513
Name:ZEPEDA, VENESSA (MED, CSC, LPC)
Entity type:Individual
Prefix:
First Name:VENESSA
Middle Name:
Last Name:ZEPEDA
Suffix:
Gender:F
Credentials:MED, CSC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5650 CEDAR TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-1221
Mailing Address - Country:US
Mailing Address - Phone:956-346-0051
Mailing Address - Fax:
Practice Address - Street 1:200 E 6TH ST
Practice Address - Street 2:
Practice Address - City:LOS FRESNOS
Practice Address - State:TX
Practice Address - Zip Code:78566-3311
Practice Address - Country:US
Practice Address - Phone:956-346-0051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-11
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
TX101YS0200X
TX69432101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool