MEDICARE: JARODD WALTER HUNDLEY LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1124500756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARODD WALTER HUNDLEY LPC

Provider Business Mailing Address
First Line	:	14200 VANCE JACKSON RD APT 22308
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-1970
Country	:	US
Telephone Number	:	318-201-2962
Fax Number	:

Provider Business Practice Location Address
First Line	:	4040 BROADWAY STE 200
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-6300
Country	:	US
Telephone Number	:	877-504-8504
Fax Number	:	855-420-6402

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/30/2018
Last Update Date	:	05/17/2022

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