Provider Demographics
NPI:1841965365
Name:THAO, TED MENGPA
Entity type:Individual
Prefix:
First Name:TED
Middle Name:MENGPA
Last Name:THAO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4242 WOODCOCK DR STE 258
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78228-1333
Mailing Address - Country:US
Mailing Address - Phone:512-798-3712
Mailing Address - Fax:
Practice Address - Street 1:4242 WOODCOCK DR STE 258
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78228-1333
Practice Address - Country:US
Practice Address - Phone:512-798-3712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2025-11-07
Deactivation Date:2025-07-22
Deactivation Code:
Reactivation Date:2025-11-07
Provider Licenses
StateLicense IDTaxonomies
TX94002101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional