Healthcare Provider Details

I. General information

NPI: 1447553201
Provider Name (Legal Business Name): BARBARA LOUISE NELSON LP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2010
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4203 WOODCOCK DR STE 202
SAN ANTONIO TX
78228-1320
US

IV. Provider business mailing address

4203 WOODCOCK DR STE 202
SAN ANTONIO TX
78228-1320
US

V. Phone/Fax

Practice location:
  • Phone: 210-733-9929
  • Fax: 210-733-9916
Mailing address:
  • Phone: 210-733-9929
  • Fax: 210-733-9916

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number13075
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: