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General NPI Number Information
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NPI Number | 1871877290
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Entity Type | Organization
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Legal Business Name | SPA EDUCATION ENTERPRISE RESOURCES
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Dates
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Enumeration Date | 10/04/2011
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Last Update Date | 10/04/2011
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Provider Practice Location Address
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Address Line | 5282 MEDICAL DRIVE STE. 140
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City | SAN ANTONIO
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State | TX
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Zip | 78254
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Country | US
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Telephone | 210-385-6459
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Fax | 210-231-0658
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Provider Business Mailing Address
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Address Line | 12439 STILLWATER CRK
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City | SAN ANTONIO
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State | TX
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Zip | 78254
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Country | US
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Telephone | 210-385-6459
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Fax | 210-231-0658
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Authorized Official
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Title or Position | CEO
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Name | MS. ALICIA GARCIA
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Credential | LPC
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Telephone | 210-385-6459
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 60445
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 60445
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License Number State | TX
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