Provider Demographics
NPI:1932923737
Name:OASIS ON THE CONCHO, PLLC
Entity type:Organization
Organization Name:OASIS ON THE CONCHO, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:LANI
Authorized Official - Middle Name:ANNETTE
Authorized Official - Last Name:WEBSTER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:325-212-9115
Mailing Address - Street 1:3221 OAK MOUNTAIN TRL
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-7327
Mailing Address - Country:US
Mailing Address - Phone:325-212-9115
Mailing Address - Fax:
Practice Address - Street 1:3131 EXECUTIVE DR
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-6801
Practice Address - Country:US
Practice Address - Phone:325-947-5021
Practice Address - Fax:325-267-2629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-09
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty