Healthcare Provider Details

I. General information

NPI: 1700010212
Provider Name (Legal Business Name): WELLSPRING OF LIFE COUNSELING & PLAY THERAPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 05/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 GRISSOM RD STE 128
SAN ANTONIO TX
78238-3038
US

IV. Provider business mailing address

5505 GRISSOM RD STE 128
SAN ANTONIO TX
78238-3038
US

V. Phone/Fax

Practice location:
  • Phone: 210-680-4747
  • Fax: 210-680-4775
Mailing address:
  • Phone: 210-680-4747
  • Fax: 210-680-4775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTINA VILLARREAL
Title or Position: LPC, OWNER
Credential: PH.D.
Phone: 210-680-4747