Provider Demographics
NPI:1619408275
Name:COUNSELING SAN ANTONIO AND WELLNESS CENTER, LLC
Entity type:Organization
Organization Name:COUNSELING SAN ANTONIO AND WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:
Authorized Official - Last Name:WYNN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:210-980-6002
Mailing Address - Street 1:602 BLUFFESTATES
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-7968
Mailing Address - Country:US
Mailing Address - Phone:210-980-6002
Mailing Address - Fax:210-465-7216
Practice Address - Street 1:7272 WURZBACH RD STE 203
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-4802
Practice Address - Country:US
Practice Address - Phone:210-980-6002
Practice Address - Fax:210-941-0886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-24
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX376791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty