Provider Demographics
NPI:1295743706
Name:EMMETT, FRANK ERWIN (PHD)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:ERWIN
Last Name:EMMETT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12050 VANCE JACKSON RD
Mailing Address - Street 2:BLDG 2 STE 201
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230
Mailing Address - Country:US
Mailing Address - Phone:210-699-8881
Mailing Address - Fax:210-699-0503
Practice Address - Street 1:12050 VANCE JACKSON RD
Practice Address - Street 2:BLDG 2 STE 201
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230
Practice Address - Country:US
Practice Address - Phone:210-699-8881
Practice Address - Fax:210-699-0503
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22545103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00N33RMedicare ID - Type Unspecified