Provider Demographics
NPI:1871609503
Name:MOLBERT, JAMIE N (LPC)
Entity type:Individual
Prefix:MR
First Name:JAMIE
Middle Name:N
Last Name:MOLBERT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6402 CLUB OAKS ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3026
Mailing Address - Country:US
Mailing Address - Phone:210-410-5839
Mailing Address - Fax:210-593-1557
Practice Address - Street 1:4242 MEDICAL DRIVE
Practice Address - Street 2:SUITE 1150
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5330
Practice Address - Country:US
Practice Address - Phone:210-410-5839
Practice Address - Fax:210-593-1557
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17038101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor