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General NPI Number Information
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NPI Number | 1427658954
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Entity Type | Organization
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Legal Business Name | BEYOND THE ROOT COUNSELING AND CONSULTING,PLLC
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Dates
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Enumeration Date | 10/26/2020
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Last Update Date | 11/24/2021
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Provider Practice Location Address
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Address Line | 24028 GAVARRA
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City | SAN ANTONIO
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State | TX
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Zip | 78261-2971
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Country | US
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Telephone | 210-937-1049
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Fax | 210-783-1054
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Provider Business Mailing Address
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Address Line | 18018 OVERLOOK LOOP STE 105 #243
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City | SAN ANTONIO
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State | TX
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Zip | 78259
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Country | US
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Telephone | 210-704-7460
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Fax | 210-783-1054
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | MRS. TAWANNA M HUDSON
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Credential | LCSW
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Telephone | 210-704-7460
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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