Provider Demographics
NPI:1265793855
Name:OMNI THERAPY CENTER
Entity type:Organization
Organization Name:OMNI THERAPY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/LEAD COUNSELOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:SR
Authorized Official - Credentials:LPC
Authorized Official - Phone:830-734-7732
Mailing Address - Street 1:2116 VETERANS BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DEL RIO
Mailing Address - State:TX
Mailing Address - Zip Code:78840-3042
Mailing Address - Country:US
Mailing Address - Phone:830-734-7732
Mailing Address - Fax:
Practice Address - Street 1:2116 VETERANS BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:DEL RIO
Practice Address - State:TX
Practice Address - Zip Code:78840-3042
Practice Address - Country:US
Practice Address - Phone:830-734-7732
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX66628101YA0400X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty