Provider Demographics
NPI:1184296725
Name:WINDER, STACY RAE (RBT)
Entity type:Individual
Prefix:
First Name:STACY
Middle Name:RAE
Last Name:WINDER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 FAWN TRCE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-6979
Mailing Address - Country:US
Mailing Address - Phone:210-739-3042
Mailing Address - Fax:
Practice Address - Street 1:700 N SAINT MARYS ST STE 1400
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78205-3535
Practice Address - Country:US
Practice Address - Phone:210-739-3042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-13
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician