Provider Demographics
NPI:1780246942
Name:ESPERANZA EATING DISORDERS CENTER, PLLC
Entity type:Organization
Organization Name:ESPERANZA EATING DISORDERS CENTER, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO, CHIEF CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:MENGDEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:210-253-9763
Mailing Address - Street 1:140 HEIMER RD.
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-5032
Mailing Address - Country:US
Mailing Address - Phone:210-253-9763
Mailing Address - Fax:210-255-1681
Practice Address - Street 1:140 HEIMER RD.
Practice Address - Street 2:SUITE 400
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-5032
Practice Address - Country:US
Practice Address - Phone:210-253-9763
Practice Address - Fax:210-255-1681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-08
Last Update Date:2023-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health