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General NPI Number Information
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NPI Number | 1568003606
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Entity Type | Individual
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Provider Name | LUCAS A BAGNARA MA, LPC
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Gender | Male
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Dates
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Enumeration Date | 09/30/2019
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Last Update Date | 09/30/2019
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Provider Practice Location Address
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Address Line | 6609 BLANCO RD STE 365
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City | SAN ANTONIO
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State | TX
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Zip | 78216-6171
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Country | US
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Telephone | 210-718-1117
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Fax |
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Provider Business Mailing Address
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Address Line | 6502 PRIME TIME
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City | SAN ANTONIO
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State | TX
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Zip | 78233-3979
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Country | US
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Telephone | 210-378-2043
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Fax |
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 78392
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License Number State | TX
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