1750903498 NPI number — 2 SPARROWS COUNSELING

Table of content: (NPI 1750903498)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750903498 NPI number — 2 SPARROWS COUNSELING

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
2 SPARROWS COUNSELING
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750903498
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6215 BROADMEADOW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78240-2261
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-833-3359
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
909 LINWAY DR STE 5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOSHEN
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46526-2435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-833-3359
Provider Business Practice Location Address Fax Number:
574-971-5383
Provider Enumeration Date:
05/16/2020

Additional Information

Authorized Official

Authorized Official Last Name:
MOLNAR
Authorized Official First Name:
JOSHUA
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
PSYCHOTHERAPIST
Authorized Official Telephone Number:
210-833-3359

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1477022549 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




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