Organization Active NPI

Vida Recovery LLC

  • Professional Counselor
  • San Antonio, TX
National Provider Identifier
1235911611
Registry record updated Mar 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
Legal business name
VIDA RECOVERY LLC
Practice address
10127 Morocco St Ste 196
San Antonio, TX 78216-3943
Phone
(830) 216-6563
Fax
(330) 595-4025
NPI assigned
Oct 19, 2023
Last updated
Mar 17, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Charles E Junkin, MA, LPC/LPCC-SNPI 1811070782
Title
Owner/Ceo
Phone
(307) 338-0274

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X Primary

Addresses

Primary practice location

10127 Morocco St Ste 196
San Antonio, TX 78216-3943

Mailing address

812 Poplar St
Jourdanton, TX 78026-2940
Phone (830) 399-5010

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20240318003653 TX Part B Supplier - Clinic/Group Practice 7618314295 Receives reassigned benefits from 1 practitioner
Practice locations: San Antonio, TX

National Provider Directory

National Provider Directory

Locations

5900 Balcones Dr
#15398
Austin, TX 78731

10127 Morocco St
Ste 196
San Antonio, TX 78216
Phone (830) 216-6563

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1697673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773705600000",
    "number": "1235911611",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "812 POPLAR ST",
            "city": "JOURDANTON",
            "state": "TX",
            "postal_code": "780262940",
            "telephone_number": "830-399-5010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10127 MOROCCO ST STE 196",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782163943",
            "telephone_number": "830-216-6563",
            "fax_number": "330-595-4025"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VIDA RECOVERY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-19",
        "last_updated": "2026-03-17",
        "certification_date": "2026-03-17",
        "status": "A",
        "authorized_official_last_name": "JUNKIN",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER/CEO",
        "authorized_official_telephone_number": "307-338-0274",
        "authorized_official_credential": "MA, LPC/LPCC-S"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.