Provider Demographics
NPI:1528626355
Name:HOLGUINGRADO CLINICAL SERVICES
Entity type:Organization
Organization Name:HOLGUINGRADO CLINICAL SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARISA
Authorized Official - Middle Name:ANDREA
Authorized Official - Last Name:HOLGUIN- GRADO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:575-494-1324
Mailing Address - Street 1:12915 JONES MALTSBERGER RD STE 202
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-4282
Mailing Address - Country:US
Mailing Address - Phone:575-494-1324
Mailing Address - Fax:
Practice Address - Street 1:12915 JONES MALTSBERGER RD STE 202
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-4282
Practice Address - Country:US
Practice Address - Phone:614-782-1747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-05
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty