Basic Information
| Provider Information | |||||||||
| NPI: | 1417284209 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VARGAS | ||||||||
| FirstName: | PATRICK | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MA, LPC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 410 S MAIN | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782041128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2108229493 | ||||||||
| FaxNumber: | 2108228733 | ||||||||
| Practice Location | |||||||||
| Address1: | 410 S MAIN | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782041128 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2108229493 | ||||||||
| FaxNumber: | 2108228733 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2009 | ||||||||
| LastUpdateDate: | 06/20/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 09/29/2016 | ||||||||
| NPIReactivationDate: | 06/20/2019 | ||||||||
| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 58749 | TX | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.