Provider Demographics
NPI:1861639577
Name:COUNSELING CENTER FOR LIVING WELL, PLLC
Entity Type:Organization
Organization Name:COUNSELING CENTER FOR LIVING WELL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:L
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:210-490-9106
Mailing Address - Street 1:10615 PERRIN BEITEL RD
Mailing Address - Street 2:STE 207
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-3138
Mailing Address - Country:US
Mailing Address - Phone:210-490-9106
Mailing Address - Fax:501-635-3832
Practice Address - Street 1:10615 PERRIN BEITEL RD
Practice Address - Street 2:STE 207
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-3138
Practice Address - Country:US
Practice Address - Phone:210-490-9106
Practice Address - Fax:501-635-3832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17708101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty