Provider Demographics
NPI:1275903569
Name:SOUTH TEXAS PSYCHOLOGICAL ASSOCIATES & CONSULTANTS, LLC
Entity Type:Organization
Organization Name:SOUTH TEXAS PSYCHOLOGICAL ASSOCIATES & CONSULTANTS, LLC
Other - Org Name:SOUTH TEXAS PSYCHOLOGICAL ASSOCIATES
Other - Org Type:Other Name
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:
Authorized Official - Last Name:AVILA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:210-504-4783
Mailing Address - Street 1:8201 ROUGHRIDER DR
Mailing Address - Street 2:
Mailing Address - City:WINDCREST
Mailing Address - State:TX
Mailing Address - Zip Code:78239-2430
Mailing Address - Country:US
Mailing Address - Phone:210-504-4783
Mailing Address - Fax:210-855-8133
Practice Address - Street 1:8201 ROUGHRIDER DR
Practice Address - Street 2:
Practice Address - City:WINDCREST
Practice Address - State:TX
Practice Address - Zip Code:78239-2430
Practice Address - Country:US
Practice Address - Phone:210-504-4783
Practice Address - Fax:210-855-8133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-30
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25320103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty