Healthcare Provider Details

I. General information

NPI: 1972078269
Provider Name (Legal Business Name): KAREN DEANN RUDD MS, LPC INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2018
Last Update Date: 10/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 BLANCO RD STE 250
SAN ANTONIO TX
78216-4368
US

IV. Provider business mailing address

709 MORNINGSIDE DR
SAN ANTONIO TX
78209-5523
US

V. Phone/Fax

Practice location:
  • Phone: 210-446-8255
  • Fax:
Mailing address:
  • Phone: 210-391-8373
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number80137
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: