Provider Demographics
NPI:1104998533
Name:GALLO VAZQUEZ, SILVIA TERESA (LPC)
Entity type:Individual
Prefix:MRS
First Name:SILVIA
Middle Name:TERESA
Last Name:GALLO VAZQUEZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13415 W CITRUS CT
Mailing Address - Street 2:
Mailing Address - City:LITCHIFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340
Mailing Address - Country:US
Mailing Address - Phone:602-999-7898
Mailing Address - Fax:480-820-7863
Practice Address - Street 1:5745 W CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85031-1842
Practice Address - Country:US
Practice Address - Phone:602-999-7898
Practice Address - Fax:480-820-7863
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC11801101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLISAC10617OtherTHERAPIST
AZLPC11801OtherTHERAPIST