Healthcare Provider Details

I. General information

NPI: 1417284209
Provider Name (Legal Business Name): PATRICK VARGAS MA, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2009
Last Update Date: 06/20/2019
Certification Date:
Deactivation Date: 09/29/2016
Reactivation Date: 06/20/2019

III. Provider practice location address

410 S MAIN SUITE 201
SAN ANTONIO TX
78204-1128
US

IV. Provider business mailing address

410 S MAIN SUITE 201
SAN ANTONIO TX
78204-1128
US

V. Phone/Fax

Practice location:
  • Phone: 210-822-9493
  • Fax: 210-822-8733
Mailing address:
  • Phone: 210-822-9493
  • Fax: 210-822-8733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number58749
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: