Healthcare Provider Details

I. General information

NPI: 1639588676
Provider Name (Legal Business Name): KUADRA CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2014
Last Update Date: 08/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 E PIEDRAS DR SUITE 262
SAN ANTONIO TX
78228-1401
US

IV. Provider business mailing address

4100 E PIEDRAS DR SUITE 262
SAN ANTONIO TX
78228-1401
US

V. Phone/Fax

Practice location:
  • Phone: 210-314-7687
  • Fax: 210-314-7494
Mailing address:
  • Phone: 210-314-7687
  • Fax: 210-314-7494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number67102
License Number StateTX

VIII. Authorized Official

Name: KHADIJAT QUADRI
Title or Position: CEO
Credential: LPC
Phone: 210-314-7687