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General NPI Number Information
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NPI Number | 1063700771
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Entity Type | Organization
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Legal Business Name | BUENA VIDA COUNSELING SERVICES
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Dates
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Enumeration Date | 07/14/2011
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Last Update Date | 07/14/2011
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Provider Practice Location Address
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Address Line | 10435 OVERLAND CRK
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City | SAN ANTONIO
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State | TX
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Zip | 78245-2331
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Country | US
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Telephone | 210-598-0843
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Fax | 210-852-2312
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Provider Business Mailing Address
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Address Line | 10435 OVERLAND CRK
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City | SAN ANTONIO
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State | TX
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Zip | 78245-2331
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Country | US
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Telephone | 210-598-0843
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Fax | 210-852-2312
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Authorized Official
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Title or Position | OWNER
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Name | MR. TRINIDAD BOTELLO JR.
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Credential |
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Telephone | 210-598-0843
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 19232
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License Number State | TX
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