Healthcare Provider Details

I. General information

NPI: 1619226867
Provider Name (Legal Business Name): CHRISTOPHER LEE SOULSBY LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2012
Last Update Date: 10/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8002 WEST AVE
SAN ANTONIO TX
78213-1865
US

IV. Provider business mailing address

PO BOX 550769
HOUSTON TX
77255-0769
US

V. Phone/Fax

Practice location:
  • Phone: 713-686-9194
  • Fax: 713-686-9413
Mailing address:
  • Phone: 713-686-9194
  • Fax: 713-686-9413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number52488
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: