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General NPI Number Information
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NPI Number | 1114548831
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Entity Type | Organization
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Legal Business Name | INTEGRAL COUNSELING AND WELLNESS, LLC
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Dates
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Enumeration Date | 05/05/2020
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Last Update Date | 05/05/2020
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Provider Practice Location Address
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Address Line | 1846 LOCKHILL SELMA RD STE 104
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City | SAN ANTONIO
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State | TX
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Zip | 78213-1551
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Country | US
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Telephone | 210-800-2113
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Fax |
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Provider Business Mailing Address
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Address Line | 1846 LOCKHILL SELMA RD STE 104
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City | SAN ANTONIO
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State | TX
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Zip | 78213-1551
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Country | US
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Telephone | 210-800-2113
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | JENNIFER SIMMONS
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Credential | LPC
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Telephone | 210-800-2113
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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