MEDICARE: SOLARA BEHAVIORAL HEALTH

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1093013278
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLARA BEHAVIORAL HEALTH

Provider Business Mailing Address
First Line	:	503 BURNSIDE DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-2952
Country	:	US
Telephone Number	:	210-213-7715
Fax Number	:

Provider Business Practice Location Address
First Line	:	1927 N SAINT MARYS ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78212-4559
Country	:	US
Telephone Number	:	210-299-1152
Fax Number	:

Authorized Official
Title or Position	:	COUNSELING TEAM LEADER
Name	:	MS. KRISTINA KATHLEEN DUPRE
Credential	:	LPC
Telephone Number	:	210-299-1152

Provider Enumeration Date	:	03/11/2011
Last Update Date	:	03/11/2011

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Directions to “SOLARA BEHAVIORAL HEALTH ” Practice Location

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