Provider Demographics
NPI:1356715254
Name:EDRALIN, JANIS
Entity type:Individual
Prefix:
First Name:JANIS
Middle Name:
Last Name:EDRALIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 E PIEDRAS DR STE 262
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1426
Mailing Address - Country:US
Mailing Address - Phone:210-535-7155
Mailing Address - Fax:
Practice Address - Street 1:4100 E PIEDRAS DR STE 262
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1426
Practice Address - Country:US
Practice Address - Phone:210-535-7155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-16
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)