Provider Demographics
NPI:1265754238
Name:EDELWEISS COUNSELING CENTER, LLC
Entity type:Organization
Organization Name:EDELWEISS COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:BIRGID
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:210-846-4284
Mailing Address - Street 1:215 MELLIFF DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-7130
Mailing Address - Country:US
Mailing Address - Phone:210-846-4284
Mailing Address - Fax:
Practice Address - Street 1:215 MELLIFF DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-7130
Practice Address - Country:US
Practice Address - Phone:210-846-4284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-18
Last Update Date:2011-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17359101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1733719-01Medicaid