| Doctor Name: | MR. MICKEY D. JETT |
| NPI Number: | 1669681029 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MDIVL, MS |
| License Number: | NBCC77094 |
| Business Practice Address: | Hhc, 82d Sus Bde Apo, AE - 09331 |
| Business Phone Number: | 3188331331 |
| Business Fax Number: | |
| Mailing Address: | 4714 Emden Hollow, SAN ANTONIO |
| State: | TX |
| Postal Code: | 78247 |
| Phone Number: | 2106531688 |
| Fax Number: | |
| NPI Enumeration Date: | 05/22/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | NBCC77094 |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |