Provider Demographics
NPI:1710423157
Name:THERESA SPENCER LLC
Entity Type:Organization
Organization Name:THERESA SPENCER LLC
Other - Org Name:THERESA SPENCER LPC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LCDC, LCPC
Authorized Official - Phone:210-526-1757
Mailing Address - Street 1:7700 BROADWAY ST
Mailing Address - Street 2:SUITE 104-117
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-3232
Mailing Address - Country:US
Mailing Address - Phone:210-526-1757
Mailing Address - Fax:
Practice Address - Street 1:2008 NW MILITARY HWY STE 4
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78213-2130
Practice Address - Country:US
Practice Address - Phone:210-526-1757
Practice Address - Fax:888-213-8256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2020-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX72387261QM0801X, 261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health