Provider Demographics
NPI:1225755689
Name:EASY RIVER COUNSELING AND WELLNESS PLLC
Entity Type:Organization
Organization Name:EASY RIVER COUNSELING AND WELLNESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:DUNNE
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCDC
Authorized Official - Phone:210-875-6374
Mailing Address - Street 1:12518 BETELGEUSE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-4855
Mailing Address - Country:US
Mailing Address - Phone:210-875-6374
Mailing Address - Fax:
Practice Address - Street 1:4081 DE ZAVALA RD # 201
Practice Address - Street 2:
Practice Address - City:SHAVANO PARK
Practice Address - State:TX
Practice Address - Zip Code:78249-2082
Practice Address - Country:US
Practice Address - Phone:210-875-6374
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty