Healthcare Provider Details

I. General information

NPI: 1134597768
Provider Name (Legal Business Name): MINDWORKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8207 CALLAGHAN RD STE 425
SAN ANTONIO TX
78230-4735
US

IV. Provider business mailing address

8207 CALLAGHAN RD STE 425
SAN ANTONIO TX
78230-4735
US

V. Phone/Fax

Practice location:
  • Phone: 210-366-3700
  • Fax:
Mailing address:
  • Phone: 210-366-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number16640
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number70305
License Number StateTX

VIII. Authorized Official

Name: MS. VICKY VELOSO
Title or Position: RECEPTIONIST
Credential:
Phone: 210-366-3700