Provider Demographics
NPI:1669506192
Name:CATHOLIC CHARITIES ARCHDIOCESE OF SAN ANTONIO INC
Entity Type:Organization
Organization Name:CATHOLIC CHARITIES ARCHDIOCESE OF SAN ANTONIO INC
Other - Org Name:CATHOLIC COUNSELING & CONSULTATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:B
Authorized Official - Last Name:KRAVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:210-377-1133
Mailing Address - Street 1:7711 MADONNA
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6620
Mailing Address - Country:US
Mailing Address - Phone:210-377-1133
Mailing Address - Fax:210-377-1230
Practice Address - Street 1:7711 MADONNA
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6620
Practice Address - Country:US
Practice Address - Phone:210-377-1133
Practice Address - Fax:210-377-1230
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHOLIC CHARITIES ARCHDIOCESE OF SAN ANTONIO INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-15
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17263101YP2500X
TX17480101YP2500X
TX18632101YP2500X
TX342981041C0700X
TX361511041C0700X
TX200928106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX161989201Medicaid
TX148203601Medicaid
TX175693402Medicaid
TX84444LOtherBCBS KRAVITZ
TX86499QOtherBCBS RUTKOWSKI
TX84446LOtherBCBS KNORR
TX143544801Medicaid
TX145955401Medicaid
TX84445LOtherBCBS KLINE
TX84445LOtherBCBS KLINE