| Vitality Life Counseling Of San Antonio Llc | |
|
12207 Jacobs Pond San Antonio TX 78253-5503 | |
| (956) 566-7814 | |
| Not Available |
| Full Name | Vitality Life Counseling Of San Antonio Llc |
|---|---|
| Speciality | Counselor |
| Location | 12207 Jacobs Pond, San Antonio, Texas |
| Authorized Official Name and Position | Mayra Cano (DIRECTOR) |
| Authorized Official Contact | 2109922715 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Vitality Life Counseling Of San Antonio Llc 12207 Jacobs Pond San Antonio TX 78253-5503 Ph: (956) 566-7814 | Vitality Life Counseling Of San Antonio Llc 12207 Jacobs Pond San Antonio TX 78253-5503 Ph: (956) 566-7814 |
| NPI Number | 1265017636 |
|---|---|
| Provider Enumeration Date | 03/16/2021 |
| Last Update Date | 03/16/2021 |
| Certification Date | 03/16/2021 |
| Medicare PECOS PAC ID | 0143612259 |
|---|---|
| Medicare Enrollment ID | O20220124001056 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265017636 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| Provider Name | Valerie Lopez |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033872452 PECOS PAC ID: 7911397807 Enrollment ID: I20211208002273 |
| Provider Name | Denetria D Brooks-james |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760521652 PECOS PAC ID: 5395106900 Enrollment ID: I20230730000162 |
| Provider Name | Jessica M Mancillas-flores |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1801548581 PECOS PAC ID: 3173972452 Enrollment ID: I20240321000658 |
| Provider Name | Mayra Cano |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1063882348 PECOS PAC ID: 3678965787 Enrollment ID: I20240501002799 |
| Provider Name | Arianna I Skinner-beck |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1821689076 PECOS PAC ID: 0143762815 Enrollment ID: I20240610001638 |
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