MEDICARE: BIBIANA BERMUDEZ STOSBERG

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	101YM0800X	Mental Health Counselor		TX

General Provider Information

NPI Number	:	1619823788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BIBIANA BERMUDEZ STOSBERG

Provider Business Mailing Address
First Line	:	1512 DEER RUN PASS
Second Line	:
City	:	CANYON LAKE
State	:	TX
Zip	:	78133-3897
Country	:	US
Telephone Number	:	512-636-9232
Fax Number	:

Provider Business Practice Location Address
First Line	:	18720 STONE OAK PKWY STE 160
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78258-4173
Country	:	US
Telephone Number	:	210-793-3311
Fax Number	:

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

Provider Enumeration Date	:	03/10/2026
Last Update Date	:	03/10/2026

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