Provider Demographics
NPI:1083012314
Name:MJK FAMILY THERAPY, LLC
Entity Type:Organization
Organization Name:MJK FAMILY THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JOANNE
Authorized Official - Last Name:KRAUS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, LCSW
Authorized Official - Phone:706-247-3515
Mailing Address - Street 1:19206 HUEBNER RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3146
Mailing Address - Country:US
Mailing Address - Phone:706-247-3515
Mailing Address - Fax:210-499-4956
Practice Address - Street 1:19206 HUEBNER RD
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3146
Practice Address - Country:US
Practice Address - Phone:706-247-3515
Practice Address - Fax:210-499-4956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-18
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX405081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty