Organization
TLG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DENISE Y JOHNSON (DIRECTOR OF CLIENT SERVICES)
(210) 316-3799
Entity
Organization
Contact information
Practice address
16170 JONES MALTSBERGER RD STE 108109, SAN ANTONIO, TX 78247-3202
(210) 316-3799
(210) 349-9983
Mailing address
16170 JONES MALTSBERGER RD STE 108109, SAN ANTONIO, TX 78247-3202
(210) 316-3799
(210) 349-9983
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YP1600X
Pastoral Counselor
—
—
103TC1900X
Counseling Psychologist
Primary
—
—
1041C0700X
Clinical Social Worker
32426
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
149705901
—
TX
Enumeration date
10/19/2012
Last updated
12/12/2012
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