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General NPI Number Information
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NPI Number | 1154085611
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Entity Type | Organization
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Legal Business Name | CANVAS MENTAL HEALTH PLLC
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Dates
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Enumeration Date | 10/29/2021
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Last Update Date | 04/10/2023
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Provider Practice Location Address
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Address Line | 14603 HUEBNER RD STE 3505
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City | SAN ANTONIO
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State | TX
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Zip | 78230-5469
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Country | US
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Telephone | 210-985-1900
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Fax | 210-985-1905
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Provider Business Mailing Address
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Address Line | PO BOX 591245
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City | SAN ANTONIO
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State | TX
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Zip | 78259-0112
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Country | US
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Telephone | 210-985-1900
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Fax | 210-985-1905
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Authorized Official
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Title or Position | MANAGER
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Name | MR. NICHOLAS H GAULTNEY
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Credential | APRN, PMHNP-BC
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Telephone | 210-985-1900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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