Provider Demographics
NPI:1730791088
Name:210 PSYCHIATRY & PSYCHOTHERAPY, PLLC
Entity type:Organization
Organization Name:210 PSYCHIATRY & PSYCHOTHERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PSYCHIATRIC NURSE PRACTITIONE
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:IRELAND
Authorized Official - Last Name:HUCKLEBERRY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN-BC
Authorized Official - Phone:210-796-2839
Mailing Address - Street 1:17281 INTERSTATE 35 S
Mailing Address - Street 2:
Mailing Address - City:ATASCOSA
Mailing Address - State:TX
Mailing Address - Zip Code:78002-5525
Mailing Address - Country:US
Mailing Address - Phone:210-843-0434
Mailing Address - Fax:210-893-2342
Practice Address - Street 1:14800 SAN PEDRO AVE STE 110
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-3734
Practice Address - Country:US
Practice Address - Phone:210-490-9850
Practice Address - Fax:210-796-2839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-18
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty