Organization
MIP SA LLC
Active
Parent organization
MIP SVC LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MIP SVC LLC
Authorized official
MS. DINA KUSHALIYEVA (DIRECTOR)
(214) 802-0224
Entity
Organization
Contact information
Practice address
901 NE LOOP 410 # 405, SAN ANTONIO, TX 78209-1305
(210) 926-5502
Mailing address
901 NE LOOP 410 # 405, SAN ANTONIO, TX 78209-1305
(210) 926-5502
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Enumeration date
03/28/2025
Last updated
09/11/2025
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