Provider Information for 1124500756
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JARODD WALTER HUNDLEY LPC
Sex: Male
NPI: 1124500756
Last Updated: 2022-05-17
Certification Date: 2022-05-17
Certification Date: 2022-05-17
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1124500756 | ||||||||
| Enumeration Date | 2018-08-30 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 14200 VANCE JACKSON RD APT 22308 SAN ANTONIO, TX 78249-1970 United States Phone: 318-201-2962 | Fax: | ||||||||
| Primary Practice Address | 4040 BROADWAY STE 200 SAN ANTONIO, TX 78209-6300 United States Phone: 877-504-8504 | Fax:855-420-6402 | ||||||||
| Secondary Practice Address(es) | 114 MORGAN ST # 3 | ||||||||
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