Provider Demographics
NPI:1396290458
Name:YMCA OF GREATER SAN ANTONIO
Entity type:Organization
Organization Name:YMCA OF GREATER SAN ANTONIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF COUNSELING AND WELL-BEI
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:GUSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-ASSOCIATE
Authorized Official - Phone:210-445-4937
Mailing Address - Street 1:5538 WALZEM RD., SUITE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78218-2103
Mailing Address - Country:US
Mailing Address - Phone:210-796-3732
Mailing Address - Fax:210-939-6369
Practice Address - Street 1:5538 WALZEM RD., SUITE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78218-2103
Practice Address - Country:US
Practice Address - Phone:210-796-3732
Practice Address - Fax:210-939-6369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-18
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty