Individual provider · Type 1 NPI
Mallory Marie Bustos
Professional Counselor · San Antonio, TX
NPI number
1912797630
Active
Practice location
1226 Stable Glen Dr
San Antonio, TX 78245-2969
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Professional Counselor Primary | 101YP2500X | 92415 (TX) |
| Mental Health Counselor | 101YM0800X | MH27163 (FL) |
Professional Counselor: Definition to come...
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About NPI 1912797630
Mallory Marie Bustos's National Provider Identifier is 1912797630, issued on May 7, 2025. The primary taxonomy on file is Professional Counselor (101YP2500X), and the practice location is in San Antonio, TX. The record was last updated on May 18, 2026.