Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor | 71049 | TX |
NPI | 1003208174 |
---|---|
Provider Name | Kacey Vasquez |
First Address | Denton, TX 76209-3572 |
Second Address | Frisco, TX 75034-7339 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/02/2015 |
Last Update Date | 03/05/2021 |