Provider Demographics
NPI:1306110648
Name:SAUCEDA, ADAM (MA, LPC)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:SAUCEDA
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8631 AUBERRY PATH
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4482
Mailing Address - Country:US
Mailing Address - Phone:210-392-8402
Mailing Address - Fax:
Practice Address - Street 1:12030 BANDERA RD STE 108J
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-4736
Practice Address - Country:US
Practice Address - Phone:210-853-0503
Practice Address - Fax:888-307-5350
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-05
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66428101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX66428OtherSTATE LICENSE