Healthcare Provider Details

I. General information

NPI: 1396290458
Provider Name (Legal Business Name): YMCA OF GREATER SAN ANTONIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 09/20/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5538 WALZEM RD., SUITE 101
SAN ANTONIO TX
78218-2103
US

IV. Provider business mailing address

5538 WALZEM RD., SUITE 101
SAN ANTONIO TX
78218-2103
US

V. Phone/Fax

Practice location:
  • Phone: 210-796-3732
  • Fax: 210-939-6369
Mailing address:
  • Phone: 210-796-3732
  • Fax: 210-939-6369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. KRISTINE MICHELLE GUSMAN
Title or Position: DIRECTOR OF COUNSELING AND WELL-BEI
Credential: LPC-ASSOCIATE
Phone: 210-445-4937