Provider Demographics
NPI:1700334604
Name:NORTHRUP THERAPY
Entity Type:Organization
Organization Name:NORTHRUP THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER, MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:NORTHRUP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-833-4011
Mailing Address - Street 1:21015 MARKET RIDGE
Mailing Address - Street 2:STE. 101
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4979
Mailing Address - Country:US
Mailing Address - Phone:210-833-4011
Mailing Address - Fax:210-496-0101
Practice Address - Street 1:21015 MARKET RIDGE
Practice Address - Street 2:STE. 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4979
Practice Address - Country:US
Practice Address - Phone:210-496-0100
Practice Address - Fax:201-496-0101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-20
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TX61536101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX61536OtherLICENSE PROFESSIONAL COUNSELOR