Provider Demographics
NPI:1154085611
Name:CANVAS MENTAL HEALTH PLLC
Entity Type:Organization
Organization Name:CANVAS MENTAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:H
Authorized Official - Last Name:GAULTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, PMHNP-BC
Authorized Official - Phone:210-985-1900
Mailing Address - Street 1:PO BOX 591245
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-0112
Mailing Address - Country:US
Mailing Address - Phone:210-985-1900
Mailing Address - Fax:210-985-1905
Practice Address - Street 1:14603 HUEBNER RD STE 3505
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-5469
Practice Address - Country:US
Practice Address - Phone:210-985-1900
Practice Address - Fax:210-985-1905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-29
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)