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General NPI Number Information
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NPI Number | 1861116618
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Entity Type | Organization
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Legal Business Name | UPPERROOM RESTORATION COUNSELING PLLC
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Dates
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Enumeration Date | 09/26/2022
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Last Update Date | 11/02/2024
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Provider Practice Location Address
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Address Line | 6502 BANDERA RD STE 101
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City | SAN ANTONIO
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State | TX
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Zip | 78238-1445
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Country | US
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Telephone | 210-838-4757
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Fax | 210-783-1777
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Provider Business Mailing Address
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Address Line | 7210 SHADOW RDG
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City | SAN ANTONIO
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State | TX
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Zip | 78250-3340
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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 | OWNER
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Name | MICHON R CHARLES
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Credential |
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Telephone | 210-382-5893
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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