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General NPI Number Information
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NPI Number | 1013642768
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Entity Type | Organization
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Legal Business Name | THE EMDR GROUP OF SOUTH TEXAS, PLLC
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Dates
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Enumeration Date | 07/18/2022
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Last Update Date | 07/22/2022
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Provider Practice Location Address
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Address Line | 29710 US HIGHWAY 281 N
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City | BULVERDE
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State | TX
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Zip | 78163-3246
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Country | US
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Telephone | 210-896-6215
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Fax |
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Provider Business Mailing Address
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Address Line | 25806 SANTOLINA
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City | SAN ANTONIO
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State | TX
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Zip | 78261-2672
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Country | US
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Telephone | 210-896-6215
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. KIMBERLY JAYE DAFFRON-BAKER
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Credential | LCSW, LPC-S, LMFT-S
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Telephone | 210-896-6215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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