Provider Demographics
NPI:1841935103
Name:ALYSSA CEDILLO COUNSELING PLLC AKA TREE OF LIFE COUNSELING CENTER
Entity type:Organization
Organization Name:ALYSSA CEDILLO COUNSELING PLLC AKA TREE OF LIFE COUNSELING CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALYSSA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CEDILLO
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S, RPT-S
Authorized Official - Phone:210-570-8898
Mailing Address - Street 1:602 W FRENCH PL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-3634
Mailing Address - Country:US
Mailing Address - Phone:210-570-8898
Mailing Address - Fax:855-568-1312
Practice Address - Street 1:602 W FRENCH PL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-3634
Practice Address - Country:US
Practice Address - Phone:210-570-8898
Practice Address - Fax:855-568-1312
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-02
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1528494515Medicaid