Provider Information for 1053917377
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Mr. NICKOLAS SCOTT RACZEK LPC
Sex: Male
NPI: 1053917377
Last Updated: 2023-11-15
Certification Date: 2023-11-15
Certification Date: 2023-11-15
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1053917377 | ||||||||
| Enumeration Date | 2020-12-10 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 6800 PARK TEN BLVD STE 200S SAN ANTONIO, TX 78213-4293 United States Phone: 210-261-1060 | Fax:210-261-1821 | ||||||||
| Primary Practice Address | 6812 BANDERA RD STE 102 SAN ANTONIO, TX 78238-1378 United States Phone: 210-261-3350 | Fax:210-261-1794 | ||||||||
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