Provider Demographics
NPI:1497438477
Name:PSYCHOTHERAPEUTIC SERVICES
Entity Type:Organization
Organization Name:PSYCHOTHERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:CARREON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:562-334-5055
Mailing Address - Street 1:5838 FORT STANWIX ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78233-5113
Mailing Address - Country:US
Mailing Address - Phone:951-900-3034
Mailing Address - Fax:951-344-8293
Practice Address - Street 1:19179 BLANCO RD STE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4009
Practice Address - Country:US
Practice Address - Phone:951-900-3034
Practice Address - Fax:951-344-8293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-08
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty