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General NPI Number Information
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NPI Number | 1205577616
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Entity Type | Individual
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Provider Name | CRISPIN FELICIANO III MS
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Gender | Male
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Dates
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Enumeration Date | 04/07/2022
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Last Update Date | 06/10/2024
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Provider Practice Location Address
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Address Line | 10410 BARBEQUE BAY
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City | CONVERSE
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State | TX
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Zip | 78109-4441
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Country | US
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Telephone | 210-608-1106
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Fax |
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Provider Business Mailing Address
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Address Line | 5900 BALCONES DR # 19797
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City | AUSTIN
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State | TX
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Zip | 78731-4257
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Country | US
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Telephone | 210-538-3132
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Fax | 210-699-7660
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 83665
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 83665
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License Number State | TX
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