Healthcare Provider Details

I. General information

NPI: 1568805745
Provider Name (Legal Business Name): SEXUAL TRAUMA & ASSAULT RESPONSE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2013
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 N CAMPBELL ST
EL PASO TX
79902-5202
US

IV. Provider business mailing address

710 N CAMPBELL ST
EL PASO TX
79902-5202
US

V. Phone/Fax

Practice location:
  • Phone: 915-533-7700
  • Fax: 915-533-6727
Mailing address:
  • Phone: 915-533-7700
  • Fax: 915-533-6727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: ROBERT SHAMY
Title or Position: FINANCE DIRECTOR
Credential:
Phone: 915-533-7700