Healthcare Provider Details

I. General information

NPI: 1275604993
Provider Name (Legal Business Name): A-OMEGA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 05/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4203 WOODCOCK DR STE 265
SAN ANTONIO TX
78228-1320
US

IV. Provider business mailing address

4203 WOODCOCK DR STE 265
SAN ANTONIO TX
78228-1320
US

V. Phone/Fax

Practice location:
  • Phone: 210-737-2674
  • Fax: 210-734-2412
Mailing address:
  • Phone: 210-737-2674
  • Fax: 210-734-2412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. MARI E RIES
Title or Position: EXECUTIVE DIRECTOR CLINICAL SERVICE
Credential: LPC
Phone: 210-737-2674