Provider Demographics
NPI:1720562887
Name:PRESTIGE GUIDANCE COUNSELING, PLLC
Entity Type:Organization
Organization Name:PRESTIGE GUIDANCE COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JAMAICA
Authorized Official - Middle Name:D
Authorized Official - Last Name:BATES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:210-954-1238
Mailing Address - Street 1:7134 ELM TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78244-1810
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7134 ELM TRAIL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78244-1810
Practice Address - Country:US
Practice Address - Phone:210-954-1238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3661472Medicaid