Organization
PSYCHOLOGICAL SERVICES, C.A.F.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. GLORIA DEAN FONDREN LPC, LSOTP (CHIEF EXECUTIVE OFFICER, CONSULTANT)
(210) 658-2280
Entity
Organization
Contact information
Practice address
8930 FOURWINDS DR, SUITE 247, SAN ANTONIO, TX 78239-1970
(210) 658-2280
(210) 945-7780
Mailing address
8930 FOURWINDS DR STE 247, SAN ANTONIO, TX 78239-1970
(210) 658-2280
(210) 945-7780
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
16060
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1219792-02
—
TX
01
—
85278L
BCBS PROVIDER ID
TX
Enumeration date
01/22/2007
Last updated
06/26/2008
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