Provider Demographics
NPI:1275099509
Name:SOUTH TEXAS BEHAVIORAL GROUP, LLC
Entity Type:Organization
Organization Name:SOUTH TEXAS BEHAVIORAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:FILOTEO
Authorized Official - Last Name:TENIENTE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCDC
Authorized Official - Phone:210-334-1407
Mailing Address - Street 1:5403 KINGSWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SCHERTZ
Mailing Address - State:TX
Mailing Address - Zip Code:78108-2503
Mailing Address - Country:US
Mailing Address - Phone:210-334-1407
Mailing Address - Fax:866-248-8533
Practice Address - Street 1:403 S WW WHITE RD STE 218
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78219-4249
Practice Address - Country:US
Practice Address - Phone:210-334-1407
Practice Address - Fax:866-248-8533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-12
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX218436803Medicaid