Healthcare Provider Details

I. General information

NPI: 1063562684
Provider Name (Legal Business Name): WILLIAM MACK ERWIN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14815 SAN PEDRO AVE
SAN ANTONIO TX
78232-3708
US

IV. Provider business mailing address

14815 SAN PEDRO AVE
SAN ANTONIO TX
78232-3708
US

V. Phone/Fax

Practice location:
  • Phone: 210-494-1991
  • Fax: 210-494-7575
Mailing address:
  • Phone: 210-494-1991
  • Fax: 210-494-7575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20855
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: