Healthcare Provider Details

I. General information

NPI: 1225324270
Provider Name (Legal Business Name): SENIOR PSYCHCARE OF SAN ANTONIO I, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 12/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4635 SOUTHWEST FWY STE 635
HOUSTON TX
77027-7112
US

IV. Provider business mailing address

4635 SOUTHWEST FWY STE 635
HOUSTON TX
77027-7112
US

V. Phone/Fax

Practice location:
  • Phone: 713-850-0049
  • Fax: 713-627-7302
Mailing address:
  • Phone: 713-850-0049
  • Fax: 713-627-7302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: RANDALL J. FRAPART
Title or Position: CHIEF FINANCIAL OFFICER
Credential: CPA
Phone: 713-850-0049