Healthcare Provider Details

I. General information

NPI: 1497078455
Provider Name (Legal Business Name): PAULA MOKRY M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2010
Last Update Date: 03/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 E MAIN ST
KERRVILLE TX
78028-3530
US

IV. Provider business mailing address

14007 FAIRWAYCOURT
SAN ANTONIO TX
78217-1643
US

V. Phone/Fax

Practice location:
  • Phone: 210-387-0815
  • Fax:
Mailing address:
  • Phone: 210-387-0815
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number64578
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number201294
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: