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General NPI Number Information
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NPI Number | 1871962191
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Entity Type | Organization
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Legal Business Name | MYPSYCH MENTAL HEALTH, PLLC
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Dates
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Enumeration Date | 09/16/2015
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Last Update Date | 04/23/2024
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Provider Practice Location Address
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Address Line | 8026 FLOYD CURL DR
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City | SAN ANTONIO
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State | TX
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Zip | 78229
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Country | US
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Telephone | 210-990-1142
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Fax |
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Provider Business Mailing Address
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Address Line | 8407 BANDERA ROAD STE 103 BOX 103448
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City | SAN ANTONIO
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State | TX
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Zip | 78250
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Country | US
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Telephone | 210-990-1142
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Fax |
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. MIKAEL JAMES JACOBSON
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Credential | MD
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Telephone | 210-363-5471
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | L5386
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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