Healthcare Provider Details

I. General information

NPI: 1720147093
Provider Name (Legal Business Name): THE ECUMENICAL CENTER FOR RELIGION AND HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 05/27/2021
Certification Date: 05/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8310 EWING HALSELL DRIVE
SAN ANTONIO TX
78229-3715
US

IV. Provider business mailing address

8310 EWING HALSELL DRIVE
SAN ANTONIO TX
78229-3715
US

V. Phone/Fax

Practice location:
  • Phone: 210-616-0885
  • Fax: 210-614-5633
Mailing address:
  • Phone: 210-616-0885
  • Fax: 210-614-5633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MS. MARY BETH FISK
Title or Position: CEO / EXECUTIVE DIRECTOR
Credential:
Phone: 210-616-0885