| Into The Roots Therapy, Pllc | |
|
4203 Gardendale St Ste C206 San Antonio TX 78229-3174 | |
| (210) 580-4149 | |
| (325) 267-7774 |
| Full Name | Into The Roots Therapy, Pllc |
|---|---|
| Speciality | Counselor |
| Location | 4203 Gardendale St Ste C206, San Antonio, Texas |
| Authorized Official Name and Position | Phi-long Le (OWNER/PROVIDER) |
| Authorized Official Contact | 5123660178 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Into The Roots Therapy, Pllc Po Box 782068 San Antonio TX 78278-2068 Ph: (210) 580-4149 | Into The Roots Therapy, Pllc 4203 Gardendale St Ste C206 San Antonio TX 78229-3174 Ph: (210) 580-4149 |
| NPI Number | 1720784903 |
|---|---|
| Provider Enumeration Date | 01/31/2023 |
| Last Update Date | 10/22/2024 |
| Certification Date | 10/22/2024 |
| Medicare PECOS PAC ID | 7517307630 |
|---|---|
| Medicare Enrollment ID | O20240506003401 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1720784903 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Phi-long Le |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1144932989 PECOS PAC ID: 8022480441 Enrollment ID: I20240524003289 |
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