MEDICARE: MR. AJAY KAPOOR

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	17640	TX
2	101YM0800X	Mental Health Counselor	101089	TX

General Provider Information

NPI Number	:	1649147059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AJAY KAPOOR

Provider Business Mailing Address
First Line	:	1751 BABCOCK RD APT 913
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-4688
Country	:	US
Telephone Number	:	210-201-6828
Fax Number	:

Provider Business Practice Location Address
First Line	:	1751 BABCOCK RD APT 913
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-4688
Country	:	US
Telephone Number	:	210-201-6828
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2025
Last Update Date	:	03/13/2026

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