Provider Demographics
NPI:1134635576
Name:ARTVANGO THERAPEUTIC SERVICES, INC.
Entity type:Organization
Organization Name:ARTVANGO THERAPEUTIC SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSE PROFESSIONAL COUNSELOR, CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:YADIRA
Authorized Official - Middle Name:G
Authorized Official - Last Name:PUENTE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:303-246-1419
Mailing Address - Street 1:3201 CHERRY RIDGE DR STE B202
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-4823
Mailing Address - Country:US
Mailing Address - Phone:210-387-2218
Mailing Address - Fax:833-571-1220
Practice Address - Street 1:3201 CHERRY RIDGE DR STE B202
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-4823
Practice Address - Country:US
Practice Address - Phone:210-387-2218
Practice Address - Fax:833-571-1220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-21
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
TX62172101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty