Healthcare Provider Details

I. General information

NPI: 1174159651
Provider Name (Legal Business Name): ROXANNE HURON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2020
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N FRIO ST BLDG 1
SAN ANTONIO TX
78207-3011
US

IV. Provider business mailing address

6800 PARK TEN BLVD STE 200S
SAN ANTONIO TX
78213-4293
US

V. Phone/Fax

Practice location:
  • Phone: 210-246-1300
  • Fax:
Mailing address:
  • Phone: 210-261-1060
  • Fax: 210-261-1821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number73027
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: