Provider Demographics
NPI:1255010948
Name:ELEVEN ELEVEN COUNSELING AND WELLNESS
Entity type:Organization
Organization Name:ELEVEN ELEVEN COUNSELING AND WELLNESS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:LEDEZMA
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:210-326-7202
Mailing Address - Street 1:10011 STAGECOACH BAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-5904
Mailing Address - Country:US
Mailing Address - Phone:210-326-7202
Mailing Address - Fax:
Practice Address - Street 1:4081 DE ZAVALA RD STE 201
Practice Address - Street 2:
Practice Address - City:SHAVANO PARK
Practice Address - State:TX
Practice Address - Zip Code:78249-2082
Practice Address - Country:US
Practice Address - Phone:210-326-7202
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-12
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)