Provider Demographics
NPI:1265742050
Name:FLATOW, EDWARD M (LPC)
Entity type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:M
Last Name:FLATOW
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9406 IPSWICH
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-2058
Mailing Address - Country:US
Mailing Address - Phone:210-389-0276
Mailing Address - Fax:
Practice Address - Street 1:10010 SAN PEDRO AVE
Practice Address - Street 2:SUITE 610
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-3862
Practice Address - Country:US
Practice Address - Phone:210-979-0202
Practice Address - Fax:210-222-8030
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64287101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health