MEDICARE: JACKLYNN VASQUEZ LPC-A

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	101YM0800X	Mental Health Counselor	100993	TX

General Provider Information

NPI Number	:	1811847874
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACKLYNN VASQUEZ LPC-A

Provider Business Mailing Address
First Line	:	1544 W DOVE AVE
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-3439
Country	:	US
Telephone Number	:	956-369-7997
Fax Number	:

Provider Business Practice Location Address
First Line	:	1544 W DOVE AVE
Second Line	:
City	:	MCALLEN
State	:	TX
Zip	:	78504-3439
Country	:	US
Telephone Number	:	956-369-7997
Fax Number	:

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

Provider Enumeration Date	:	01/30/2026
Last Update Date	:	01/30/2026

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