Basic Information
Provider Information
NPI: 1558301374
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WELZ
FirstName: TRINA
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: LPC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3031 IH 10 W
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782015159
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 711 E JOSEPHINE ST
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782081027
CountryCode: US
TelephoneNumber: 2107311300
FaxNumber: 2107388025
Other Information
ProviderEnumerationDate: 06/08/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YP2500X18882TXY Behavioral Health & Social Service ProvidersCounselorProfessional

No ID Information.


Home