Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist |
NPI | 1073265039 |
---|---|
Provider Name | Mckenna Hereford |
First Address | San Antonio, TX 78229-4404 |
Second Address | San Antonio, TX 78229-4404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2022 |
Last Update Date | 21/01/2022 |