MEDICARE: CHRONIC PAIN RESOURCE CENTER OF SOUTH TEXAS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	261QM0850X	Adult Mental Health Clinic/Center
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1811486921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRONIC PAIN RESOURCE CENTER OF SOUTH TEXAS

Provider Business Mailing Address
First Line	:	980 TALLEY RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-5228
Country	:	US
Telephone Number	:	830-745-3488
Fax Number	:

Provider Business Practice Location Address
First Line	:	980 TALLEY RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78253-5228
Country	:	US
Telephone Number	:	830-745-3488
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	SALINA SHELTON
Credential	:	LPC
Telephone Number	:	830-745-3488

Provider Enumeration Date	:	05/03/2018
Last Update Date	:	10/17/2024

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