Native Life

Primary specialty

Pastoral CounselorTaxonomy code 101YP1600X

Legal business name

NATIVE LIFE

Practice address

2017 W Mulberry Ave
San Antonio, TX 78201-4957

Phone

(210) 606-1710

NPI assigned

Jun 30, 2015

Organization subpart

No

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

Authorized official

Name

Mr. Mark Baez, MA/MA/CSP/LCDC/CART

Title

Mental Health Practitioner/Ed. Psyc

Phone

(210) 606-1710

Specialties & licenses 4

Addresses

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

{
    "created_epoch": "1435622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435622400000",
    "number": "1639552383",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2017 W MULBERRY AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782014957",
            "telephone_number": "210-606-1710"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2017 W MULBERRY AVE",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782014957",
            "telephone_number": "210-606-1710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NATIVE LIFE",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-30",
        "last_updated": "2015-06-30",
        "status": "A",
        "authorized_official_last_name": "BAEZ",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "MENTAL HEALTH PRACTITIONER/ED. PSYC",
        "authorized_official_telephone_number": "210-606-1710",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MA/MA/CSP/LCDC/CART"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "TX",
            "license": "8472",
            "primary": false
        },
        {
            "code": "101YP1600X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Pastoral",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "AZ",
            "license": "3556573",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "AZ",
            "license": "3556573",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pastoral Counselor in San Antonio, TX
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.