=====================================================
General NPI Number Information
=====================================================
NPI Number | 1629355953
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RUBEN M AGUIRRE SR. PSY.D, LPC-S, LCDC
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2011
-----------------------------------------------------
Last Update Date | 07/21/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1201 W PEARL ST APT B9
-----------------------------------------------------
City | GRANBURY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76048-1841
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-765-1115
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1809 N CYPRESS AVE
-----------------------------------------------------
City | STEPHENVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76401-2243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-413-5455
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 20150
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------