Provider Demographics
NPI:1487001392
Name:HUCKLEBERRY, SEAN (LPC, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:HUCKLEBERRY
Suffix:
Gender:M
Credentials:LPC, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Mailing Address - Fax:
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:210-893-2342
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-20
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1008202363LP0808X, 363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health