Provider Demographics
NPI:1871862060
Name:JANKOWSKI, KYLE (LMFT)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:
Last Name:JANKOWSKI
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14400 NORTHBROOK DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-5077
Mailing Address - Country:US
Mailing Address - Phone:830-708-4919
Mailing Address - Fax:
Practice Address - Street 1:14400 NORTHBROOK DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-5077
Practice Address - Country:US
Practice Address - Phone:830-708-4919
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX201233106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist