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General NPI Number Information
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NPI Number | 1730791088
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Entity Type | Organization
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Legal Business Name | 210 PSYCHIATRY & PSYCHOTHERAPY, PLLC
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Dates
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Enumeration Date | 08/18/2020
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Last Update Date | 08/09/2021
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Provider Practice Location Address
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Address Line | 14800 SAN PEDRO AVE STE 110
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City | SAN ANTONIO
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State | TX
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Zip | 78232-3734
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Country | US
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Telephone | 210-490-9850
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Fax | 210-796-2839
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Provider Business Mailing Address
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Address Line | 17281 INTERSTATE 35 S
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City | ATASCOSA
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State | TX
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Zip | 78002-5525
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Country | US
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Telephone | 210-843-0434
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Fax | 210-893-2342
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Authorized Official
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Title or Position | OWNER/PSYCHIATRIC NURSE PRACTITIONE
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Name | MR. SEAN IRELAND HUCKLEBERRY
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Credential | APRN-BC
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Telephone | 210-796-2839
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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