Healthcare Provider Details

I. General information

NPI: 1255719449
Provider Name (Legal Business Name): YADIRA G PUENTE LPC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: YADIRA GANDARA

II. Dates (important events)

Enumeration Date: 05/08/2015
Last Update Date: 07/13/2022
Certification Date: 07/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 CHERRY RIDGE DR STE C318
SAN ANTONIO TX
78230-4826
US

IV. Provider business mailing address

3201 CHERRY RIDGE ST STE C318
SAN ANTONIO TX
78230-4826
US

V. Phone/Fax

Practice location:
  • Phone: 210-387-2218
  • Fax: 833-571-1220
Mailing address:
  • Phone: 210-387-2218
  • Fax: 833-571-1220

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number62172
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: