Healthcare Provider Details

I. General information

NPI: 1700514932
Provider Name (Legal Business Name): STEPHANIE CUEBAS VAZQUEZ LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2022
Last Update Date: 06/24/2024
Certification Date: 06/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 MARSHALL RD
BILOXI MS
39531-4747
US

IV. Provider business mailing address

6675 BALBOA CIR
OCEAN SPRINGS MS
39564-2304
US

V. Phone/Fax

Practice location:
  • Phone: 228-300-6586
  • Fax:
Mailing address:
  • Phone: 787-307-5611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP-0838
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3123
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: