Provider Demographics
NPI:1407349137
Name:CONCEIVABLE RESOLUTIONS PLLC
Entity Type:Organization
Organization Name:CONCEIVABLE RESOLUTIONS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GOODRUM
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCDC, CART
Authorized Official - Phone:210-288-1835
Mailing Address - Street 1:212 CHESTNUT ST STE 2
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78202-2720
Mailing Address - Country:US
Mailing Address - Phone:210-288-1835
Mailing Address - Fax:210-932-9891
Practice Address - Street 1:212 CHESTNUT ST STE 2
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78202-2720
Practice Address - Country:US
Practice Address - Phone:210-288-1835
Practice Address - Fax:210-932-9891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health