Healthcare Provider Details

I. General information

NPI: 1548164668
Provider Name (Legal Business Name): VAZQUEZ COUNSELING SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 N MOUNTAIN AVE STE 219
UPLAND CA
91786-4165
US

IV. Provider business mailing address

818 N MOUNTAIN AVE STE 219
UPLAND CA
91786-4165
US

V. Phone/Fax

Practice location:
  • Phone: 626-483-9319
  • Fax: 909-608-1804
Mailing address:
  • Phone: 626-483-9319
  • Fax: 909-608-1804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. MANUEL RODRIGUEZ VAZQUEZ
Title or Position: LMFT
Credential: MS
Phone: 626-483-9319