Healthcare Provider Details

I. General information

NPI: 1275036782
Provider Name (Legal Business Name): DUANE ANTOLIN SNAPE MS, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2018
Last Update Date: 05/24/2020
Certification Date: 05/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1866 NACOGDOCHES RD
SAN ANTONIO TX
78209-2216
US

IV. Provider business mailing address

4201 MEDICAL DR
SAN ANTONIO TX
78229-5656
US

V. Phone/Fax

Practice location:
  • Phone: 210-547-8090
  • Fax: 800-579-5926
Mailing address:
  • Phone: 210-614-4991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number73574
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: