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General NPI Number Information
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NPI Number | 1093013278
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Entity Type | Organization
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Legal Business Name | SOLARA BEHAVIORAL HEALTH
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Dates
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Enumeration Date | 03/11/2011
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Last Update Date | 03/11/2011
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Provider Practice Location Address
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Address Line | 1927 N SAINT MARYS ST
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City | SAN ANTONIO
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State | TX
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Zip | 78212-4559
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Country | US
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Telephone | 210-299-1152
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Fax |
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Provider Business Mailing Address
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Address Line | 503 BURNSIDE DR
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City | SAN ANTONIO
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State | TX
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Zip | 78209-2952
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Country | US
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Telephone | 210-213-7715
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Fax |
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Authorized Official
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Title or Position | COUNSELING TEAM LEADER
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Name | MS. KRISTINA KATHLEEN DUPRE
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Credential | LPC
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Telephone | 210-299-1152
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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