Healthcare Provider Details

I. General information

NPI: 1396669578
Provider Name (Legal Business Name): KELSEY CANAVAN MANTZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2026
Last Update Date: 08/08/2026
Certification Date: 08/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 VANDERHECK ST APT 2
SAN ANTONIO TX
78209-4045
US

IV. Provider business mailing address

219 KENNEDY AVE
SAN ANTONIO TX
78209-5247
US

V. Phone/Fax

Practice location:
  • Phone: 210-865-7979
  • Fax:
Mailing address:
  • Phone: 210-865-7979
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number105479
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: