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General NPI Number Information
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NPI Number | 1467442434
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Entity Type | Individual
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Provider Name | JIMMY DANIEL HENRY MSW, LCSW-S
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Gender | Male
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Dates
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Enumeration Date | 10/21/2005
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Last Update Date | 10/16/2023
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Provider Practice Location Address
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Address Line | 6029 CARRIAGE CPE
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City | SAN ANTONIO
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State | TX
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Zip | 78261-2242
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Country | US
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Telephone | 210-268-6125
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Fax | 419-745-8425
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Provider Business Mailing Address
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Address Line | 18235 BULVERDE RD SUITE 105, #36
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City | SAN ANTONIO
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State | TX
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Zip | 78259
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Country | US
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Telephone | 210-268-6125
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Fax | 419-745-8425
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 30555
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License Number State | TX
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