MEDICARE: STOP PROGRAMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	10216	TX

General Provider Information

NPI Number	:	1063606259
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STOP PROGRAMS

Provider Business Mailing Address
First Line	:	8820 BROADWAY ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-6318
Country	:	US
Telephone Number	:	210-826-8686
Fax Number	:	210-826-8624

Provider Business Practice Location Address
First Line	:	8820 BROADWAY ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78217-6318
Country	:	US
Telephone Number	:	210-826-8686
Fax Number	:	210-826-8624

Authorized Official
Title or Position	:	OWNER
Name	:	MR. JAMES B KEEDY
Credential	:	LPC, LSOTP, LMFT
Telephone Number	:	210-826-8686

Provider Enumeration Date	:	08/30/2007
Last Update Date	:	08/30/2007

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Directions to “STOP PROGRAMS ” Practice Location

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