Provider Demographics
NPI:1184926263
Name:PERSONAL TRANSFORMATION WELLNESS GROUP, INC.
Entity type:Organization
Organization Name:PERSONAL TRANSFORMATION WELLNESS GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LOURDES
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUILAR-LANDIN
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LPC, LMFT
Authorized Official - Phone:210-495-0675
Mailing Address - Street 1:P.O. BOX 591337
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-0116
Mailing Address - Country:US
Mailing Address - Phone:210-495-0675
Mailing Address - Fax:210-495-0884
Practice Address - Street 1:510 MED COURT,
Practice Address - Street 2:STE. #106
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4203
Practice Address - Country:US
Practice Address - Phone:210-495-0675
Practice Address - Fax:210-495-0884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-23
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty