Provider Demographics
NPI:1710384631
Name:MENTAL HEALTH PROFESSIONALS OF SAN ANTONIO
Entity Type:Organization
Organization Name:MENTAL HEALTH PROFESSIONALS OF SAN ANTONIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:ARIEL
Authorized Official - Last Name:KOPLIN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:210-865-2484
Mailing Address - Street 1:1703 N LOOP 1604 W APT 1203
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4679
Mailing Address - Country:US
Mailing Address - Phone:210-865-2484
Mailing Address - Fax:
Practice Address - Street 1:1703 N LOOP 1604 W APT 1203
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4679
Practice Address - Country:US
Practice Address - Phone:210-865-2484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-20
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX700915364SP0808X
TXAP126831364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental HealthGroup - Multi-Specialty