Provider Demographics
NPI:1427250786
Name:FERRELL, JACK GORDON (PHD)
Entity type:Individual
Prefix:
First Name:JACK
Middle Name:GORDON
Last Name:FERRELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14310 NORTHBROOK DR
Mailing Address - Street 2:SUITE120
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-5048
Mailing Address - Country:US
Mailing Address - Phone:210-499-5025
Mailing Address - Fax:210-499-5825
Practice Address - Street 1:14310 NORTHBROOK DR
Practice Address - Street 2:SUITE120
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-5048
Practice Address - Country:US
Practice Address - Phone:210-499-5025
Practice Address - Fax:210-499-5825
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20880103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic