Provider Demographics
NPI:1659022424
Name:COURAGEOUS STORY COUNSELING, PLLC
Entity Type:Organization
Organization Name:COURAGEOUS STORY COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:ARLENE
Authorized Official - Last Name:KRATKY
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, LCDC, NCC
Authorized Official - Phone:210-791-7017
Mailing Address - Street 1:3201 CHERRY RIDGE DR STE C316
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-4823
Mailing Address - Country:US
Mailing Address - Phone:210-791-7017
Mailing Address - Fax:830-323-0144
Practice Address - Street 1:3201 CHERRY RIDGE DR STE C316
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-4823
Practice Address - Country:US
Practice Address - Phone:210-347-9480
Practice Address - Fax:830-323-0144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-13
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)