=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437334653
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ISAAC CARREON MFT
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/07/2008
-----------------------------------------------------
Last Update Date | 08/31/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 19179 BLANCO RD STE
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78258-4009
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-900-3034
-----------------------------------------------------
Fax | 951-344-8293
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5838 FORT STANWIX ST
-----------------------------------------------------
City | SAN ANTONIO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78233-5113
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-900-3034
-----------------------------------------------------
Fax | 951-344-8293
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 47440
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------