Healthcare Provider Details

I. General information

NPI: 1891052403
Provider Name (Legal Business Name): KRISTINE JOHNSTON GERWELL, PH.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 04/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 LEWIS ST
SAN ANTONIO TX
78212-5538
US

IV. Provider business mailing address

130 LEWIS ST
SAN ANTONIO TX
78212-5538
US

V. Phone/Fax

Practice location:
  • Phone: 210-829-7471
  • Fax: 210-829-5398
Mailing address:
  • Phone: 210-829-7471
  • Fax: 210-829-5398

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number228590
License Number StateTX

VIII. Authorized Official

Name: DR. KRISTINE JOHNSTON GERWELL
Title or Position: OWNER/ CLINICAL DIRECTOR
Credential: PH.D.
Phone: 210-829-7471