Healthcare Provider Details

I. General information

NPI: 1497273890
Provider Name (Legal Business Name): CHRISTINA M MOKHTAR HASSAN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 12/04/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 NE LOOP 410 STE D200
SAN ANTONIO TX
78209-1407
US

IV. Provider business mailing address

125 WELLNESS WAY
HOT SPRINGS AR
71913-6478
US

V. Phone/Fax

Practice location:
  • Phone: 210-822-2600
  • Fax: 210-822-2685
Mailing address:
  • Phone: 501-620-5231
  • Fax: 501-620-5109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2105005
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number92874
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: