MEDICARE: BRANDAN VAZQUEZ LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	90945	TX
2	101YP2500X	Professional Counselor	PRC15434	DC

General Provider Information

NPI Number	:	1164016150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDAN VAZQUEZ LPC

Provider Business Mailing Address
First Line	:	1919 TAYLOR ST STE F
Second Line	:	#1029
City	:	HOUSTON
State	:	TX
Zip	:	77007-3973
Country	:	US
Telephone Number	:	832-205-8390
Fax Number	:

Provider Business Practice Location Address
First Line	:	1919 TAYLOR ST STE F
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77007-3973
Country	:	US
Telephone Number	:	832-205-8390
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2021
Last Update Date	:	04/05/2023

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Directions to “ BRANDAN VAZQUEZ LPC” Practice Location

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