Healthcare Provider Details

I. General information

NPI: 1982908299
Provider Name (Legal Business Name): COUNSELINK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2010
Last Update Date: 12/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 W GATE BLVD STE. D-404
AUSTIN TX
78745-1479
US

IV. Provider business mailing address

4701 W GATE BLVD STE. D-404
AUSTIN TX
78745-1479
US

V. Phone/Fax

Practice location:
  • Phone: 512-659-3518
  • Fax: 512-899-8300
Mailing address:
  • Phone: 512-659-3518
  • Fax: 512-899-8300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number10685
License Number StateTX

VIII. Authorized Official

Name: MR. GENARO SANDOVAL
Title or Position: CEO
Credential: B.A., LCDC, CART
Phone: 512-659-3518