Healthcare Provider Details

I. General information

NPI: 1679788608
Provider Name (Legal Business Name): ALBERT A EISCH LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2007
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4203 WOODCOCK DR SUITE 265
SAN ANTONIO TX
78228-1320
US

IV. Provider business mailing address

4203 WOODCOCK DR SUITE 265
SAN ANTONIO TX
78228-1320
US

V. Phone/Fax

Practice location:
  • Phone: 210-737-2674
  • Fax: 210-734-2412
Mailing address:
  • Phone: 210-737-2674
  • Fax: 210-734-2412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10394
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: