Basic Information
| Provider Information | |||||||||
| NPI: | 1619408275 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COUNSELING SAN ANTONIO AND WELLNESS CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 602 BLUFFESTATES | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782167968 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109806002 | ||||||||
| FaxNumber: | 2104657216 | ||||||||
| Practice Location | |||||||||
| Address1: | 7272 WURZBACH RD STE 203 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782404802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109806002 | ||||||||
| FaxNumber: | 2109410886 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2017 | ||||||||
| LastUpdateDate: | 01/28/2022 | ||||||||
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| AuthorizedOfficialLastName: | WYNN | ||||||||
| AuthorizedOfficialFirstName: | ALISON | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2109806002 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
| NPICertificationDate: | 01/28/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 37679 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.