Individual
DR. MARIO GEORGE NICOLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D
Contact information
Practice address
1100 WILFORD HALL LOOP, BLDG 4554, ATTN: 59 MDW/SGHC, JBSA LACKLAND, TX 78236
(210) 292-6225
Mailing address
1100 WILFORD HALL LOOP BLDG 4554, JBSA LACKLAND, TX 78236-5638
(210) 292-6225
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
37499
TX
Other
Enumeration date
11/08/2006
Last updated
08/25/2023
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