Healthcare Provider Details

I. General information

NPI: 1366220154
Provider Name (Legal Business Name): JESSICA M. MANCILLAS-FLORES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2023
Last Update Date: 09/21/2023
Certification Date: 09/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11230 SIERRA TRL
SAN ANTONIO TX
78254-2826
US

IV. Provider business mailing address

PO BOX 564
HELOTES TX
78023-0564
US

V. Phone/Fax

Practice location:
  • Phone: 210-990-1951
  • Fax:
Mailing address:
  • Phone: 210-990-1951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: JESSICA M MANCILLAS-FLORES
Title or Position: PRESIDENT
Credential: LPC
Phone: 210-990-1951