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General NPI Number Information
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NPI Number | 1447934070
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Entity Type | Individual
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Provider Name | JALIECE KING
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Gender | Female
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Dates
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Enumeration Date | 06/14/2023
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Last Update Date | 06/14/2023
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Provider Practice Location Address
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Address Line | 4242 MEDICAL DR BLDG 3
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City | SAN ANTONIO
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State | TX
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Zip | 78229-5640
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Country | US
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Telephone | 210-981-4593
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Fax |
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Provider Business Mailing Address
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Address Line | 5380 MEDICAL DR APT 101
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City | SAN ANTONIO
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State | TX
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Zip | 78240-1949
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 87059
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License Number State | TX
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