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General NPI Number Information
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NPI Number | 1588550776
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Entity Type | Individual
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Provider Name | MIA LYNN COVARRUBIAS
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Gender | Female
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Dates
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Enumeration Date | 06/16/2025
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 17300 HENDERSON PASS STE 270
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City | SAN ANTONIO
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State | TX
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Zip | 78232-1568
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Country | US
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Telephone | 210-622-2877
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Fax |
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Provider Business Mailing Address
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Address Line | 1800 BROADWAY ST APT 1221
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City | SAN ANTONIO
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State | TX
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Zip | 78215-1332
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Country | US
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Telephone | 210-392-8784
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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 | 99060
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License Number State | TX
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