Individual
MARY JANE NATIVIDAD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MED LPC
Contact information
Practice address
401 E SONTERRA BLVD STE 375, SAN ANTONIO, TX 78258-4321
(210) 325-6874
(210) 267-9072
Mailing address
7627 DERBY RUN, SELMA, TX 78154-3936
(210) 325-6874
(210) 267-9072
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
19403
TX
101YM0800X
Mental Health Counselor
19403
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
178701201
—
TX
01
—
LBW61
MEDICAID PIN
TX
Enumeration date
10/12/2006
Last updated
03/15/2024
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