Healthcare Provider Details

I. General information

NPI: 1780246942
Provider Name (Legal Business Name): ESPERANZA EATING DISORDERS CENTER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2019
Last Update Date: 05/13/2023
Certification Date: 05/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 HEIMER RD. SUITE 400
SAN ANTONIO TX
78232-5032
US

IV. Provider business mailing address

140 HEIMER RD. SUITE 400
SAN ANTONIO TX
78232-5032
US

V. Phone/Fax

Practice location:
  • Phone: 210-253-9763
  • Fax: 210-255-1681
Mailing address:
  • Phone: 210-253-9763
  • Fax: 210-255-1681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License Number
License Number State

VIII. Authorized Official

Name: SUSAN C MENGDEN
Title or Position: CEO, CHIEF CLINICAL DIRECTOR
Credential: PHD
Phone: 210-253-9763