Healthcare Provider Details

I. General information

NPI: 1871148122
Provider Name (Legal Business Name): OPEN TO HEALING INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2019
Last Update Date: 08/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18756 STONE OAK PKWY STE 200
SAN ANTONIO TX
78258-4354
US

IV. Provider business mailing address

15106 OAK LOFT ST
SAN ANTONIO TX
78232-4617
US

V. Phone/Fax

Practice location:
  • Phone: 210-309-2006
  • Fax: 210-598-0468
Mailing address:
  • Phone: 210-309-2006
  • Fax: 210-598-0468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NOLAN MARTINEZ
Title or Position: LPC/CEO
Credential: LPC
Phone: 210-309-2006