Provider Demographics
NPI:1598481129
Name:MATA, SARAH GRACE (BCABA)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:GRACE
Last Name:MATA
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 N SAINT MARYS ST STE 1400
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-3535
Mailing Address - Country:US
Mailing Address - Phone:210-866-3780
Mailing Address - Fax:
Practice Address - Street 1:605 FREEMONT
Practice Address - Street 2:
Practice Address - City:SPRING BRANCH
Practice Address - State:TX
Practice Address - Zip Code:78070-3701
Practice Address - Country:US
Practice Address - Phone:903-746-9221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-14
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9124103K00000X
TX40906748106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst