MEDICARE: DR. MITRA KERMANI PHD

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	103TC1900X	Counseling Psychologist
2	101Y00000X	Counselor	C5278	OR
3	101YM0800X	Mental Health Counselor	C5278	OR

General Provider Information

NPI Number	:	1821500075
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MITRA KERMANI PHD

Provider Business Mailing Address
First Line	:	29 TROPHY RDG
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-7715
Country	:	US
Telephone Number	:	210-473-9258
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 E SONTERRA BLVD STE 300
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4315
Country	:	US
Telephone Number	:	210-473-9258
Fax Number	:

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

Provider Enumeration Date	:	10/27/2017
Last Update Date	:	02/18/2026

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