Healthcare Provider Details

I. General information

NPI: 1568540938
Provider Name (Legal Business Name): RUTH N FAGAN WILEN MSW PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11107 WURZBACH RD #604
SAN ANTONIO TX
78230
US

IV. Provider business mailing address

3010 WHISPER LARK
SAN ANTONIO TX
78230
US

V. Phone/Fax

Practice location:
  • Phone: 210-219-0055
  • Fax: 210-692-1265
Mailing address:
  • Phone: 210-219-0055
  • Fax: 210-692-1265

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW 00277
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number86 LMFT
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: