Provider Demographics
NPI:1710399688
Name:FREEDOM RESTORATION COUNSELING PLLC
Entity Type:Organization
Organization Name:FREEDOM RESTORATION COUNSELING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:MRS
Authorized Official - First Name:AHNA
Authorized Official - Middle Name:E N
Authorized Official - Last Name:MINK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-789-0897
Mailing Address - Street 1:1162 E SONTERRA BLVD
Mailing Address - Street 2:STE. 130
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4047
Mailing Address - Country:US
Mailing Address - Phone:210-789-0897
Mailing Address - Fax:
Practice Address - Street 1:1162 E SONTERRA BLVD
Practice Address - Street 2:STE. 130
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4047
Practice Address - Country:US
Practice Address - Phone:210-789-0897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201777106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX722310OtherVALUE OPTIONS/MOS