Provider Demographics
NPI:1013642768
Name:THE EMDR GROUP OF SOUTH TEXAS, PLLC
Entity Type:Organization
Organization Name:THE EMDR GROUP OF SOUTH TEXAS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:JAYE
Authorized Official - Last Name:DAFFRON-BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, LPC-S, LMFT-S
Authorized Official - Phone:210-896-6215
Mailing Address - Street 1:25806 SANTOLINA
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78261-2672
Mailing Address - Country:US
Mailing Address - Phone:210-896-6215
Mailing Address - Fax:
Practice Address - Street 1:29710 US HIGHWAY 281 N
Practice Address - Street 2:
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163-3246
Practice Address - Country:US
Practice Address - Phone:210-896-6215
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-18
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty