Provider Demographics
NPI:1831213255
Name:OTWAY, RHONDA B (MFT)
Entity type:Individual
Prefix:MS
First Name:RHONDA
Middle Name:B
Last Name:OTWAY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:RHONDA
Other - Middle Name:
Other - Last Name:BUSSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:24165 W IH 10 # 217-620
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1159
Mailing Address - Country:US
Mailing Address - Phone:830-302-8540
Mailing Address - Fax:925-901-0234
Practice Address - Street 1:8000 FAIR OAKS PKWY
Practice Address - Street 2:SUITE 204
Practice Address - City:FAIR OAKS RANCH
Practice Address - State:TX
Practice Address - Zip Code:78015-4739
Practice Address - Country:US
Practice Address - Phone:830-302-8540
Practice Address - Fax:925-901-0234
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2015-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 42530106H00000X
TX202178106H00000X
CALPCC542101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional