Healthcare Provider Details

I. General information

NPI: 1396588679
Provider Name (Legal Business Name): RAQUEL VARGAS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

233 E MAIN ST
BOZEMAN MT
59715-4977
US

IV. Provider business mailing address

2320 W GLENLAKE AVE APT 3
CHICAGO IL
60659-5227
US

V. Phone/Fax

Practice location:
  • Phone: 504-313-5302
  • Fax:
Mailing address:
  • Phone: 786-493-0536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.017151
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number180.015661
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: