| Jason Northrup | |
|
500 N Loop 1604 E Ste 220 San Antonio TX 78232-1238 | |
| (210) 496-0100 | |
| Not Available |
| Full Name | Jason Northrup |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 500 N Loop 1604 E Ste 220, San Antonio, Texas |
| Authorized Official Name and Position | Jason Conrad Northrup (OWNER) |
| Authorized Official Contact | 8064387003 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jason Northrup 3226 Falcon Grove Dr San Antonio TX 78247-5103 Ph: (210) 833-4011 | Jason Northrup 500 N Loop 1604 E Ste 220 San Antonio TX 78232-1238 Ph: (210) 496-0100 |
| NPI Number | 1770891004 |
|---|---|
| Provider Enumeration Date | 09/21/2010 |
| Last Update Date | 06/17/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770891004 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101Y00000X | Counselor | 62058 (Texas) | Secondary |
| 106H00000X | Marriage & Family Therapist | 200911 (Texas) | Primary |
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