MEDICARE: ALTA HEALTH, LLC

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	261QM0850X	Adult Mental Health Clinic/Center

General Provider Information

NPI Number	:	1083579478
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ALTA HEALTH, LLC

Provider Business Mailing Address
First Line	:	501 S AUSTIN AVE UNIT 1410
Second Line	:
City	:	GEORGETOWN
State	:	TX
Zip	:	78626-5640
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14135 MIDWAY RD STE G100
Second Line	:
City	:	ADDISON
State	:	TX
Zip	:	75001-3611
Country	:	US
Telephone Number	:	210-237-7163
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	STEVE THOMASON
Credential	:	LMSW, LCDC
Telephone Number	:	737-444-1239

Provider Enumeration Date	:	12/18/2025
Last Update Date	:	12/18/2025

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Directions to “ALTA HEALTH, LLC ” Practice Location

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