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General NPI Number Information
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NPI Number | 1598236465
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Entity Type | Individual
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Provider Name | DEMETRIUS RANOD DONSEROUX LPC
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Gender | Male
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Dates
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Enumeration Date | 12/17/2018
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Last Update Date | 12/17/2018
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Provider Practice Location Address
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Address Line | 19595 IH 10 W
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City | SAN ANTONIO
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State | TX
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Zip | 78257-9520
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Country | US
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Telephone | 210-698-6868
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Fax |
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Provider Business Mailing Address
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Address Line | 30258 SETTERFELD CIR
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City | BOERNE
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State | TX
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Zip | 78015-2101
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Country | US
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Telephone | 210-698-6868
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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 | LH60509753
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License Number State | WA
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