Healthcare Provider Details

I. General information

NPI: 1487689998
Provider Name (Legal Business Name): DIRK MAGDAHL JAKOB PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: DIRK MAGDAHL

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12050 VANCE JACKSON RD STE 201
SAN ANTONIO TX
78230-1183
US

IV. Provider business mailing address

12050 VANCE JACKSON RD BLDG. 2 SUITE 201
SAN ANTONIO TX
78230-1182
US

V. Phone/Fax

Practice location:
  • Phone: 210-699-8881
  • Fax: 210-699-0503
Mailing address:
  • Phone: 210-699-8881
  • Fax: 210-699-0503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number11324
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: