Healthcare Provider Details

I. General information

NPI: 1649563016
Provider Name (Legal Business Name): RAUL URESTE LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2011
Last Update Date: 05/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 E. MITCHELL
SAN ANTONIO TX
78210
US

IV. Provider business mailing address

1514 W SUMMIT AVE
SAN ANTONIO TX
78201-5150
US

V. Phone/Fax

Practice location:
  • Phone: 210-335-7500
  • Fax:
Mailing address:
  • Phone: 210-326-2620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number65779
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: