Provider Demographics
NPI:1457826620
Name:MINDFUL CONNECTIONS OF SOUTH TEXAS THERAPY & CONSULTING
Entity Type:Organization
Organization Name:MINDFUL CONNECTIONS OF SOUTH TEXAS THERAPY & CONSULTING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:O
Authorized Official - Last Name:VILLARREAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-633-4627
Mailing Address - Street 1:PO BOX 23422
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78223-0422
Mailing Address - Country:US
Mailing Address - Phone:210-962-1663
Mailing Address - Fax:210-817-8687
Practice Address - Street 1:6609 BLANCO RD STE 365
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6171
Practice Address - Country:US
Practice Address - Phone:210-920-1663
Practice Address - Fax:210-817-8687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-03
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty