Provider Demographics
NPI:1437899184
Name:MOBLEY-WICKER, TAMARA L
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:L
Last Name:MOBLEY-WICKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4119 KNOLLBLUFF
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-2108
Mailing Address - Country:US
Mailing Address - Phone:210-823-4958
Mailing Address - Fax:
Practice Address - Street 1:4119 KNOLLBLUFF
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-2108
Practice Address - Country:US
Practice Address - Phone:210-823-4958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18793101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional