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General NPI Number Information
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NPI Number | 1124073150
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Entity Type | Organization
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Legal Business Name | SOLARA BEHAVIORAL HEALTH SAN ANTONIO, LLP
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 09/26/2012
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Provider Practice Location Address
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Address Line | 1975 BABCOCK RD SUITE 140
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City | SAN ANTONIO
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State | TX
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Zip | 78229-4585
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Country | US
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Telephone | 281-914-1012
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Fax | 682-831-9625
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Provider Business Mailing Address
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Address Line | 1975 BABCOCK RD SUITE 140
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City | SAN ANTONIO
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State | TX
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Zip | 78229-4585
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Country | US
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Telephone | 281-914-1012
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Fax | 682-831-9625
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Authorized Official
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Title or Position | MANAGER
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Name | MR. NATHAN DANIEL INGRAM
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Credential |
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Telephone | 281-914-1012
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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