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General NPI Number Information
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NPI Number | 1780769265
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Entity Type | Organization
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Legal Business Name | OUR LADY OF THE LAKE UNIVERSITY
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 06/09/2008
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Provider Practice Location Address
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Address Line | 590 NORTH GENERAL MCMULLEN 3
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City | SAN ANTONIO
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State | TX
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Zip | 78228
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Country | US
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Telephone | 210-434-1054
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Fax | 210-434-1380
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Provider Business Mailing Address
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Address Line | 590 NORTH GENERAL MCMULLEN 3
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City | SAN ANTONIO
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State | TX
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Zip | 78228
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Country | US
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Telephone | 210-434-1054
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Fax | 210-434-1380
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Authorized Official
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Title or Position | CLINIC DIRECTOR
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Name | MRS. BERNADETTE SOLORZANO
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Credential | PSYD
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Telephone | 210-434-1054
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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 | 16408
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License Number State | TX
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