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General NPI Number Information
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NPI Number | 1043742406
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Entity Type | Organization
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Legal Business Name | LGM COUNSELING CENTER, LLC
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Dates
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Enumeration Date | 04/03/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 302 E JOSEPHINE ST STE 1101
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City | SAN ANTONIO
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State | TX
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Zip | 78215-1161
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Country | US
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Telephone | 210-618-9680
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 591637
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City | SAN ANTONIO
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State | TX
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Zip | 78259-0131
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Country | US
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Telephone | 210-618-9680
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LORENA MEDELLIN
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Credential |
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Telephone | 210-618-9680
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 53351
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License Number State | TX
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