Healthcare Provider Details

I. General information

NPI: 1396254769
Provider Name (Legal Business Name): M&L BEHAVIORAL HEALTH CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2017
Last Update Date: 10/20/2023
Certification Date: 10/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8626 TESORO DR STE 490
SAN ANTONIO TX
78217-6217
US

IV. Provider business mailing address

8626 TESORO DR STE 490
SAN ANTONIO TX
78217-6217
US

V. Phone/Fax

Practice location:
  • Phone: 210-202-0100
  • Fax:
Mailing address:
  • Phone: 210-202-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number33976
License Number StateTX

VIII. Authorized Official

Name: DR. DEBRA J ARCHULETA
Title or Position: CLINICAL HEALTH PSYCHOLOGIST
Credential: PHD
Phone: 210-202-0100