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General NPI Number Information
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NPI Number | 1326322314
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Entity Type | Individual
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Provider Name | MINA M O'CONNELL MS, LMFT
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Gender | Female
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Dates
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Enumeration Date | 10/07/2011
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Last Update Date | 04/11/2012
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Provider Practice Location Address
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Address Line | 21714 HARDY OAK SUITE 104
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City | SAN ANTONIO
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State | TX
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Zip | 78258-4839
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Country | US
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Telephone | 850-878-2245
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Fax | 830-537-3568
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Provider Business Mailing Address
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Address Line | 111 SUNRISE DR
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City | BOERNE
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State | TX
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Zip | 78006-7896
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 201680
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License Number State | TX
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