Healthcare Provider Details

I. General information

NPI: 1689928186
Provider Name (Legal Business Name): TEXAS PSYCHOLOGICAL AND CONSULTATION SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2012
Last Update Date: 06/19/2020
Certification Date: 06/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21031 MARKET RDG
SAN ANTONIO TX
78258-2483
US

IV. Provider business mailing address

21031 MARKET RDG
SAN ANTONIO TX
78258-2483
US

V. Phone/Fax

Practice location:
  • Phone: 210-233-6148
  • Fax: 210-399-8721
Mailing address:
  • Phone: 210-233-6148
  • Fax: 210-399-8721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number34699
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number34699
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number34699
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY KIMBALL
Title or Position: MANAGER
Credential: PHD
Phone: 210-233-6148