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General NPI Number Information
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NPI Number | 1992921019
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Entity Type | Organization
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Legal Business Name | STBM LLC
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 12050 VANCE JACKSON BLDG. 2, STE. 201
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City | SAN ANTONIO
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State | TX
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Zip | 78230-1183
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Country | US
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Telephone | 210-699-8881
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Fax | 210-699-0503
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Provider Business Mailing Address
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Address Line | 12050 VANCE JACKSON BLDG. 2, STE. 201
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City | SAN ANTONIO
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State | TX
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Zip | 78230-1183
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Country | US
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Telephone | 210-699-8881
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Fax | 210-699-0503
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. DIANE PENA
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Credential |
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Telephone | 210-699-8881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1884
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 22545
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License Number State | TX
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