Provider Demographics
NPI:1487689998
Name:MAGDAHL JAKOB, DIRK (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIRK
Middle Name:
Last Name:MAGDAHL JAKOB
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:DIRK
Other - Middle Name:
Other - Last Name:MAGDAHL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12050 VANCE JACKSON RD
Mailing Address - Street 2:BLDG. 2 SUITE 201
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1182
Mailing Address - Country:US
Mailing Address - Phone:210-699-8881
Mailing Address - Fax:210-699-0503
Practice Address - Street 1:12050 VANCE JACKSON RD STE 201
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-1183
Practice Address - Country:US
Practice Address - Phone:210-699-8881
Practice Address - Fax:210-699-0503
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11324101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX155349701Medicaid