Individual
MR. JACK BANNIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMFT, LPC
Contact information
Practice address
11230 WEST AVE STE 1203, SAN ANTONIO, TX 78213-1359
(210) 320-2999
(210) 320-4716
Mailing address
15403 AIROLE WAY, SAN ANTONIO, TX 78232-4013
(210) 825-9969
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
18744
TX
106H00000X
Marriage & Family Therapist
Primary
5072
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163782902
—
TX
Enumeration date
08/30/2006
Last updated
05/22/2024
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