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NPI Code Detail

MEDICARE: THE VINE WELLNESS GROUP, LLC

MEDICARE: THE VINE WELLNESS GROUP, LLC
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1316570971
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE VINE WELLNESS GROUP, LLC
Provider Business Mailing Address
First Line : 14802 JONES MALTSBERGER RD STE 1101
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78247-3571
Country : US
Telephone Number :
Fax Number : 210-519-2758
Provider Business Practice Location Address
First Line : 14802 JONES MALTSBERGER RD STE 1101
Second Line :
City : SAN ANTONIO
State : TX
Zip : 78247-3571
Country : US
Telephone Number : 210-490-4419
Fax Number : 210-519-2758
Authorized Official
Title or Position : CO-OWNER
Name : CELESTE INMAN
Credential : LPC-S
Telephone Number : 210-602-2203
Provider Enumeration Date : 02/21/2020
Last Update Date : 02/21/2020

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Directions to “THE VINE WELLNESS GROUP, LLC ” Practice Location

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