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General NPI Number Information
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NPI Number | 1629980404
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Entity Type | Organization
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Legal Business Name | KINTSUGI COGNITIVE PLLC
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Dates
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Enumeration Date | 09/17/2026
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Last Update Date | 09/17/2026
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Provider Practice Location Address
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Address Line | 11122 WURZBACH RD STE 201C
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City | SAN ANTONIO
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State | TX
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Zip | 78230-2575
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Country | US
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Telephone | 210-660-8402
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Fax |
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Provider Business Mailing Address
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Address Line | 11122 WURZBACH RD STE 201C
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City | SAN ANTONIO
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State | TX
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Zip | 78230-2575
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Country | US
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Telephone | 210-660-8402
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Fax |
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Authorized Official
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Title or Position | CCO
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Name | PATRICIA MOJDARA
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Credential | PHD
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Telephone | 210-632-3950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | 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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 171400000X
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Taxonomy Name | Health & Wellness Coach
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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