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General NPI Number Information
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NPI Number | 1699307173
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Entity Type | Organization
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Legal Business Name | KINGDOM OUTREACH CENTER OF SAN ANTONIO, TX
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Dates
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Enumeration Date | 02/12/2020
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Last Update Date | 02/12/2020
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Provider Practice Location Address
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Address Line | KINGDOM OUT REACH CENTER OF SAN ANTONIO 3819 NACO PERRIN BLVD #118
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City | SAN ANTONIO
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State | TX
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Zip | 78217
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Country | US
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Telephone | 210-687-9715
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Fax |
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Provider Business Mailing Address
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Address Line | 6027 RED ROSE
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City | SAN ANTONIO
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State | TX
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Zip | 78244-4431
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LEAD CONSULTANT
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Name | KENNETH BROWN
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Credential | LCPC
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Telephone | 210-687-9715
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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