MEDICARE: MS. LESLIE PATRICIA VANAMAN L.P.C., L.C.D.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	64211	TX
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	11148	TX

General Provider Information

NPI Number	:	1417274382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LESLIE PATRICIA VANAMAN L.P.C., L.C.D.C.

Provider Business Mailing Address
First Line	:	5804 BABCOCK RD # 142
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-2134
Country	:	US
Telephone Number	:	351-537-6109
Fax Number	:

Provider Business Practice Location Address
First Line	:	11467 HUEBNER RD STE 180
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-1073
Country	:	US
Telephone Number	:	361-537-6109
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2010
Last Update Date	:	06/29/2022

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