Basic Information
| Provider Information | |||||||||
| NPI: | 1619987633 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FURLIN | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 802 EMERALD BAY | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782587804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104813860 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4242 MEDICAL DR STE 6300 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782295372 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106148400 | ||||||||
| FaxNumber: | 2106148165 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 10830 | TX | X | Behavioral Health & Social Service Providers | Counselor | Professional | 106H00000X | 2596 | TX | X | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.