Provider Demographics
NPI:1649519422
Name:VAZQUEZ, ROGER (PHD, LPC, LCDC,HSBCP)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:PHD, LPC, LCDC,HSBCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 JULIE RIVERS DR
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3144
Mailing Address - Country:US
Mailing Address - Phone:281-277-8811
Mailing Address - Fax:281-277-8827
Practice Address - Street 1:402 JULIE RIVERS DR
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3144
Practice Address - Country:US
Practice Address - Phone:281-277-8811
Practice Address - Fax:281-277-8827
Is Sole Proprietor?:No
Enumeration Date:2013-02-13
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11647101YA0400X
TX69149101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX341269401Medicaid