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General NPI Number Information
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NPI Number | 1982908299
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Entity Type | Organization
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Legal Business Name | COUNSELINK, INC.
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Dates
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Enumeration Date | 12/29/2010
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Last Update Date | 12/29/2010
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Provider Practice Location Address
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Address Line | 4701 W GATE BLVD STE. D-404
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City | AUSTIN
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State | TX
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Zip | 78745-1479
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Country | US
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Telephone | 512-659-3518
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Fax | 512-899-8300
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Provider Business Mailing Address
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Address Line | 4701 W GATE BLVD STE. D-404
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City | AUSTIN
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State | TX
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Zip | 78745-1479
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Country | US
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Telephone | 512-659-3518
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Fax | 512-899-8300
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Authorized Official
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Title or Position | CEO
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Name | MR. GENARO SANDOVAL
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Credential | B.A., LCDC, CART
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Telephone | 512-659-3518
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 10685
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License Number State | TX
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