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General NPI Number Information
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NPI Number | 1245384007
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Entity Type | Organization
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Legal Business Name | PSYCHOLOGICAL SERVICES, C.A.F.
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Dates
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Enumeration Date | 01/22/2007
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Last Update Date | 06/26/2008
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Provider Practice Location Address
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Address Line | 8930 FOURWINDS DR SUITE 247
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City | SAN ANTONIO
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State | TX
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Zip | 78239-1970
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Country | US
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Telephone | 210-658-2280
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Fax | 210-945-7780
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Provider Business Mailing Address
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Address Line | 8930 FOURWINDS DR STE 247
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City | SAN ANTONIO
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State | TX
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Zip | 78239-1970
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Country | US
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Telephone | 210-658-2280
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Fax | 210-945-7780
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER, CONSULTANT
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Name | MS. GLORIA DEAN FONDREN
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Credential | LPC, LSOTP
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Telephone | 210-658-2280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 16060
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License Number State | TX
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