Provider Demographics
NPI:1639716590
Name:SOUND MIND PSYCHOTHERAPY, PLLC
Entity Type:Organization
Organization Name:SOUND MIND PSYCHOTHERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:
Authorized Official - First Name:GABRIELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:KERSHNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-594-5993
Mailing Address - Street 1:1814 CAVERSHAM PASS LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-6055
Mailing Address - Country:US
Mailing Address - Phone:563-594-5993
Mailing Address - Fax:
Practice Address - Street 1:1814 CAVERSHAM PASS LN
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-6055
Practice Address - Country:US
Practice Address - Phone:563-594-5993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty