MEDICARE: MR. HOWARD BENJAMIN KRAVITZ LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	18632	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	84444L	OTHER	TX	KRAVITZ BCBS

General Provider Information

NPI Number	:	1053432609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. HOWARD BENJAMIN KRAVITZ LPC

Provider Business Mailing Address
First Line	:	1844 LOCKHILL SELMA RD
Second Line	:	SUITE 101
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1503
Country	:	US
Telephone Number	:	210-377-1133
Fax Number	:	210-377-1230

Provider Business Practice Location Address
First Line	:	1844 LOCKHILL SELMA RD
Second Line	:	SUITE 101
City	:	SAN ANTONIO
State	:	TX
Zip	:	78213-1503
Country	:	US
Telephone Number	:	210-377-1133
Fax Number	:	210-377-1230

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2007
Last Update Date	:	07/09/2007

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