=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427737907
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMARIS LARISSA URBY SANCHEZ LPC-S
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2023
-----------------------------------------------------
Last Update Date | 10/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11107 WURZBACH RD STE 202
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78230-2553
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-501-7662
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5804 BABCOCK RD # 239
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78240-2134
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-872-5659
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 71106
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------