Basic Information
| Provider Information | |||||||||
| NPI: | 1588946560 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MINK | ||||||||
| FirstName: | AHNA | ||||||||
| MiddleName: | E. N. | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1222 N. MAIN | ||||||||
| Address2: | STE. 740 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102717411 | ||||||||
| FaxNumber: | 2102719414 | ||||||||
| Practice Location | |||||||||
| Address1: | 1222 N. MAIN | ||||||||
| Address2: | STE. 740 | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102717411 | ||||||||
| FaxNumber: | 2102719414 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2011 | ||||||||
| LastUpdateDate: | 09/15/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFC40043 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.