=====================================================
General NPI Number Information
=====================================================
NPI Number | 1023704186
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICK SPENCER
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2023
-----------------------------------------------------
Last Update Date | 07/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 133 WINDY MEADOWS DR STE 101
-----------------------------------------------------
City | SCHERTZ
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78154-1543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-672-2553
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 133 WINDY MEADOWS DR STE 101
-----------------------------------------------------
City | SCHERTZ
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78154-1543
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 210-672-2553
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106E00000X
-----------------------------------------------------
Taxonomy Name | Assistant Behavior Analyst
-----------------------------------------------------
License Number | 0-25-16079
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------