Provider Demographics
NPI:1992405773
Name:VILLAREAL, VANESSA J (LCSW)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:J
Last Name:VILLAREAL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27911 CASTLE PARK LN
Mailing Address - Street 2:
Mailing Address - City:FULSHEAR
Mailing Address - State:TX
Mailing Address - Zip Code:77441-1765
Mailing Address - Country:US
Mailing Address - Phone:347-424-5831
Mailing Address - Fax:
Practice Address - Street 1:27911 CASTLE PARK LN
Practice Address - Street 2:
Practice Address - City:FULSHEAR
Practice Address - State:TX
Practice Address - Zip Code:77441-1765
Practice Address - Country:US
Practice Address - Phone:347-424-5831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-09
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX603411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty