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General NPI Number Information
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NPI Number | 1295607315
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Entity Type | Organization
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Legal Business Name | MPAC TEXAS MENTAL HEALTH, PLLC
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Dates
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Enumeration Date | 09/18/2025
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Last Update Date | 12/22/2025
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Provider Practice Location Address
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Address Line | 501 OGDEN ST
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City | SAN ANTONIO
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State | TX
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Zip | 78212-4325
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Country | US
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Telephone | 888-705-8722
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Fax |
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Provider Business Mailing Address
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Address Line | 2045 W GRAND AVE STE B28354
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City | CHICAGO
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State | IL
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Zip | 60612-1576
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MICHAEL WILLS
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Credential |
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Telephone | 248-515-1770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional 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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