Healthcare Provider Details

I. General information

NPI: 1134589328
Provider Name (Legal Business Name): JENNIFER A. FORSBERG, PH.D., PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2016
Last Update Date: 03/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 VILLAGE DR SUITE 209
SAN ANTONIO TX
78217-5412
US

IV. Provider business mailing address

8800 VILLAGE DR SUITE 209
SAN ANTONIO TX
78217-5412
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 Code103TC1900X
TaxonomyCounseling Psychologist
License Number32478
License Number StateTX

VIII. Authorized Official

Name: DR. JENNIFER FORSBERG
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 512-636-9770