Davis Psychological Health & Wellness Practice, Pllc | |
1100 Nw Loop 410 Ste 700 San Antonio TX 78213-2263 | |
(210) 241-4954 | |
(210) 957-1628 |
Full Name | Davis Psychological Health & Wellness Practice, Pllc |
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Speciality | Clinic/Center |
Location | 1100 Nw Loop 410, San Antonio, Texas |
Authorized Official Name and Position | Regina G. Davis (OWNER/LICENSED PSYCHOLOGIST) |
Authorized Official Contact | 2102414954 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Davis Psychological Health & Wellness Practice, Pllc 11703 Huebner Rd Ste 106-147 San Antonio TX 78230-1201 Ph: (210) 241-4954 | Davis Psychological Health & Wellness Practice, Pllc 1100 Nw Loop 410 Ste 700 San Antonio TX 78213-2263 Ph: (210) 241-4954 |
NPI Number | 1578977468 |
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Provider Enumeration Date | 06/18/2014 |
Last Update Date | 06/18/2014 |
Medicare PECOS PAC ID | 7618193863 |
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Medicare Enrollment ID | O20140723001711 |
Identifier | Type | State | Issuer |
---|---|---|---|
1578977468 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
251S00000X | Community/behavioral Health | 34154 (Texas) | Secondary |
261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | 34154 (Texas) | Primary |
Provider Name | Regina G Davis |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1326374836 PECOS PAC ID: 0547499279 Enrollment ID: I20140129001127 |
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