Provider Demographics
NPI:1184299315
Name:VASQUEZ, MARISA M (LPC)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:M
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:LPC
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Mailing Address - Street 1:17503 LA CANTERA PKWY
Mailing Address - Street 2:STE 104 PMB 293
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-8207
Mailing Address - Country:US
Mailing Address - Phone:210-564-9116
Mailing Address - Fax:210-564-9087
Practice Address - Street 1:17503 LA CANTERA PKWY
Practice Address - Street 2:STE 104 PMB 293
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-8207
Practice Address - Country:US
Practice Address - Phone:210-564-9116
Practice Address - Fax:210-564-9087
Is Sole Proprietor?:No
Enumeration Date:2021-05-20
Last Update Date:2025-01-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX81473101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional