Healthcare Provider Details

I. General information

NPI: 1801236237
Provider Name (Legal Business Name): JAMIE HUMPAL LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JAMIE MERSHON LPC

II. Dates (important events)

Enumeration Date: 06/30/2013
Last Update Date: 06/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 CROSSROADS BLVD STE 250
SAN ANTONIO TX
78201-6523
US

IV. Provider business mailing address

12526 LA MANANA ST
SAN ANTONIO TX
78233-6331
US

V. Phone/Fax

Practice location:
  • Phone: 210-736-0106
  • Fax: 210-736-2609
Mailing address:
  • Phone: 210-273-8372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number68530
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: