Healthcare Provider Details

I. General information

NPI: 1659264588
Provider Name (Legal Business Name): MOPANI MENTAL HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2025
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4715 FREDERICKSBURG RD STE 103
SAN ANTONIO TX
78229-3600
US

IV. Provider business mailing address

4715 FREDERICKSBURG RD STE 103
SAN ANTONIO TX
78229-3600
US

V. Phone/Fax

Practice location:
  • Phone: 830-391-8934
  • Fax:
Mailing address:
  • Phone: 830-391-8934
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: FAITH COMFORT MAMOMBE
Title or Position: CO-OWNER
Credential:
Phone: 830-391-8934