MEDICARE: MRS. SARAH GABRIELA POWELL BCBA, LBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	2240	TX

General Provider Information

NPI Number	:	1083024707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SARAH GABRIELA POWELL BCBA, LBA

Provider Business Mailing Address
First Line	:	14100 SAN PEDRO AVE STE 412
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78232-2009
Country	:	US
Telephone Number	:	210-281-8669
Fax Number	:	210-314-5044

Provider Business Practice Location Address
First Line	:	24200 IH 10 W STE 109
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257-1150
Country	:	US
Telephone Number	:	210-263-9443
Fax Number	:	210-314-5044

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2014
Last Update Date	:	09/15/2021

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