Provider Demographics
NPI:1578154571
Name:OBSIDIAN COUNSELING SERVICES PLLC
Entity Type:Organization
Organization Name:OBSIDIAN COUNSELING SERVICES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DIRECTOR OF CLINICAL SERVICE
Authorized Official - Prefix:
Authorized Official - First Name:CARISSMA
Authorized Official - Middle Name:TEMPEST
Authorized Official - Last Name:HUGHES-MENDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:210-505-9140
Mailing Address - Street 1:1029 GATE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78154-2823
Mailing Address - Country:US
Mailing Address - Phone:210-505-9140
Mailing Address - Fax:
Practice Address - Street 1:1029 GATE CREEK LN
Practice Address - Street 2:
Practice Address - City:SCHERTZ
Practice Address - State:TX
Practice Address - Zip Code:78154-2823
Practice Address - Country:US
Practice Address - Phone:210-505-9140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-01
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty