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Individual

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Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PH.D.

Contact information

Practice address
147 W SUNSET RD, SUITE 200, SAN ANTONIO, TX 78209-2676
(210) 858-1900
(210) 745-4525
Mailing address
147 W SUNSET RD, SUITE 200, SAN ANTONIO, TX 78209-2676
(210) 858-1900
(210) 745-4525

Taxonomy

Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
2-5100
TX
103TC0700X
Clinical Psychologist
Primary
25100
TX
103TC2200X
Clinical Child & Adolescent Psychologist
2-5100
TX
103TH0100X
Health Service Psychologist
2-5100
TX
246ZE0500X
EEG Specialist/Technologist
246ZE0600X
Electroneurodiagnostic Specialist/Technologist

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
038942103
TX
Enumeration date
07/27/2006
Last updated
07/09/2012
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