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General NPI Number Information
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NPI Number | 1760116545
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Entity Type | Organization
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Legal Business Name | ISAIAH D. JAMISON COMMUNITY WELLNESS CENTER
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Dates
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Enumeration Date | 07/15/2022
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Last Update Date | 07/22/2022
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Provider Practice Location Address
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Address Line | 4635 LA BAHIA WAY
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City | SAN ANTONIO
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State | TX
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Zip | 78253-5086
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Country | US
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Telephone | 408-806-1888
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Fax |
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Provider Business Mailing Address
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Address Line | 4635 LA BAHIA WAY
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City | SAN ANTONIO
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State | TX
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Zip | 78253-5086
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Country | US
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Telephone | 408-806-1888
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MRS. AUTRY JAMISON
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Credential | LMFT
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Telephone | 408-806-1888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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