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General NPI Number Information
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NPI Number | 1649653908
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Entity Type | Organization
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Legal Business Name | MIND SIGHT LLC
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Dates
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Enumeration Date | 07/06/2015
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Last Update Date | 07/06/2015
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Provider Practice Location Address
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Address Line | 1314 FONTAINE DR
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City | SAN ANTONIO
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State | TX
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Zip | 78219-2515
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Country | US
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Telephone | 210-819-1435
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Fax | 210-503-5867
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Provider Business Mailing Address
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Address Line | 1314 FONTAINE DR
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City | SAN ANTONIO
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State | TX
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Zip | 78219-2515
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Country | US
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Telephone | 210-819-1435
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Fax | 210-503-5867
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Authorized Official
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Title or Position | OWNER
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Name | CARLA LEE GROVES
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Credential | LCSW
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Telephone | 210-819-1435
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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 | 60147
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License Number State | TX
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