Provider Demographics
NPI:1730217977
Name:VAZQUEZ, STEVEN R (PHD, LPC, LMFT)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
Last Name:VAZQUEZ
Suffix:
Gender:M
Credentials:PHD, LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 SOUTHRIDGE CT
Mailing Address - Street 2:SUITE 105
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76053-4392
Mailing Address - Country:US
Mailing Address - Phone:817-268-7050
Mailing Address - Fax:817-285-7729
Practice Address - Street 1:1241 SOUTHRIDGE CT
Practice Address - Street 2:SUITE 105
Practice Address - City:HURST
Practice Address - State:TX
Practice Address - Zip Code:76053-4392
Practice Address - Country:US
Practice Address - Phone:817-268-7050
Practice Address - Fax:817-285-7729
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6477101Y00000X
TX001174043056106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist