MEDICARE: KEITLINA GENAO

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

General Provider Information

NPI Number	:	1205616141
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEITLINA GENAO

Provider Business Mailing Address
First Line	:	6730 N LOOP 1604 E # 73101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-5011
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6730 N LOOP 1604 E # 73101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-5011
Country	:	US
Telephone Number	:	210-774-0361
Fax Number	:

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

Provider Enumeration Date	:	09/28/2023
Last Update Date	:	09/28/2023

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Directions to “ KEITLINA GENAO ” Practice Location

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