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General NPI Number Information
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NPI Number | 1861159857
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Entity Type | Organization
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Legal Business Name | SUN PSYCHOLOGICAL
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Dates
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Enumeration Date | 11/24/2021
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Last Update Date | 11/24/2021
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Provider Practice Location Address
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Address Line | 1901 NW MILITARY HWY STE 112
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City | SAN ANTONIO
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State | TX
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Zip | 78213-2132
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Country | US
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Telephone | 201-864-6124
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Fax |
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Provider Business Mailing Address
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Address Line | 614 WALNUT HILL ST
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City | SAN ANTONIO
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State | TX
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Zip | 78232-2713
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Country | US
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Telephone | 917-774-1335
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JENNIFER CLEVELAND
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Credential | PHD
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Telephone | 917-774-1335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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