Provider Demographics
NPI:1134589328
Name:JENNIFER A. FORSBERG, PH.D., PLLC
Entity type:Organization
Organization Name:JENNIFER A. FORSBERG, PH.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:FORSBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:512-636-9770
Mailing Address - Street 1:8800 VILLAGE DR
Mailing Address - Street 2:SUITE 209
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5412
Mailing Address - Country:US
Mailing Address - Phone:210-202-0100
Mailing Address - Fax:
Practice Address - Street 1:8800 VILLAGE DR
Practice Address - Street 2:SUITE 209
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5412
Practice Address - Country:US
Practice Address - Phone:210-202-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32478103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty