MEDICARE: SOUTH TEXAS PSYCHOTHERAPY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	101YA0400X	Addiction (Substance Use Disorder) Counselor
3	101YM0800X	Mental Health Counselor
4	106H00000X	Marriage & Family Therapist
5	101YP1600X	Pastoral Counselor
6	102X00000X	Poetry Therapist
7	104100000X	Social Worker
8	1041C0700X	Clinical Social Worker
9	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1194001131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH TEXAS PSYCHOTHERAPY

Provider Business Mailing Address
First Line	:	900 NE LOOP 410
Second Line	:	SUITE D-101
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-1410
Country	:	US
Telephone Number	:	210-822-2600
Fax Number	:	210-822-2685

Provider Business Practice Location Address
First Line	:	900 NE LOOP 410
Second Line	:	SUITE D-101
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-1410
Country	:	US
Telephone Number	:	210-822-2600
Fax Number	:	210-822-2685

Authorized Official
Title or Position	:	OWNER, LEAD CLINICIAN
Name	:	MRS. CHERYL LYNNE SHULTER
Credential	:	LPC
Telephone Number	:	210-822-2600

Provider Enumeration Date	:	10/21/2011
Last Update Date	:	10/21/2011

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Directions to “SOUTH TEXAS PSYCHOTHERAPY ” Practice Location

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