Healthcare Provider Details

I. General information

NPI: 1336253145
Provider Name (Legal Business Name): DAVID HENRY DEBUSMAN L.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 04/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2391 NE LOOP 410 SUITE 120
SAN ANTONIO TX
78217-5675
US

IV. Provider business mailing address

2391 NE LOOP 410 SUITE 120
SAN ANTONIO TX
78217-5675
US

V. Phone/Fax

Practice location:
  • Phone: 210-222-0152
  • Fax: 210-222-1392
Mailing address:
  • Phone: 210-222-0152
  • Fax: 210-222-1392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number64384
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: