MEDICARE: MR. JERRY RANGEL LMSW, LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	00825	TX

General Provider Information

NPI Number	:	1396847612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JERRY RANGEL LMSW, LMFT

Provider Business Mailing Address
First Line	:	6003 CLEARBROOK ST.
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78234
Country	:	US
Telephone Number	:	210-521-4163
Fax Number	:

Provider Business Practice Location Address
First Line	:	4455 HORIZON HILL BLVD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-2258
Country	:	US
Telephone Number	:	210-321-2714
Fax Number	:	210-321-2728

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/05/2006
Last Update Date	:	07/08/2007

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