Individual provider Active NPI

Nicole Jennifer Vazoulas, LPC

  • Professional Counselor
  • Cedar Park, TX
National Provider Identifier
1316547086
Registry record updated Nov 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
88546 Issued in TX
Practice address
3000 Polar LN Ste 101
Cedar Park, TX 78613-3065
Phone
(512) 201-4006
NPI assigned
Oct 30, 2020
Last updated
Nov 11, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X
Professional Counselor 101YP2500X 88546 TX Primary

Addresses

Primary practice location

3000 Polar LN Ste 101
Cedar Park, TX 78613-3065

Mailing address

3000 Polar LN Ste 101
Cedar Park, TX 78613-3065
Phone (512) 201-4006

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241120003952 TX Practitioner - Mental Health Counselor 7911432422 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Family Care Center LLCGroup PAC ID 5991064420, 703 clinicians

Practice addresses (Care Compare)

1411 Medical Pkwy
Suite 201
Cedar Park, TX 78613-2696
Phone (888) 374-5066

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
88546TXMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Family Care Center LLC, CurrentSince Mar 5, 2025 Accepting new patients
Family Care Center, LLC Mental Health CurrentSince Mar 5, 2025 Accepting new patients

Locations

1411 Medical Pkwy
Ste 201
Cedar Park, TX 78613
Phone (254) 715-8443

551 S Interstate 35
Ste 200
Round Rock, TX 78664
Phone (512) 241-7314

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1604016000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731283200000",
    "number": "1316547086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3000 POLAR LN STE 101",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786133065",
            "telephone_number": "512-201-4006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 POLAR LN STE 101",
            "city": "CEDAR PARK",
            "state": "TX",
            "postal_code": "786133065",
            "telephone_number": "512-201-4006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAZOULAS",
        "first_name": "NICOLE",
        "middle_name": "JENNIFER",
        "credential": "LPC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-30",
        "last_updated": "2024-11-11",
        "certification_date": "2024-11-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "TX",
            "license": "88546",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cedar Park, TX

Sources for this page

Verify at the official NPI Registry.