Healthcare Provider Details

I. General information

NPI: 1316091200
Provider Name (Legal Business Name): PEGASUS SCHOOLS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

896 ROBIN RANCH RD
LOCKHART TX
78644-4578
US

IV. Provider business mailing address

PO BOX 577
LOCKHART TX
78644-0577
US

V. Phone/Fax

Practice location:
  • Phone: 512-376-2101
  • Fax:
Mailing address:
  • Phone: 512-376-2101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number844396
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment Facility
License Number844396
License Number StateTX

VIII. Authorized Official

Name: ROBERTA SMITH
Title or Position: BILLING SPECIALIST
Credential:
Phone: 512-432-1602