MEDICARE: SA YOUTH

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

General Provider Information

NPI Number	:	1841029501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SA YOUTH

Provider Business Mailing Address
First Line	:	1215 W POPLAR ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78207-1835
Country	:	US
Telephone Number	:	210-223-3131
Fax Number	:

Provider Business Practice Location Address
First Line	:	1215 W POPLAR ST
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78207-1835
Country	:	US
Telephone Number	:	210-223-3131
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT, CEO
Name	:	MARIA BENAVIDEZ
Credential	:
Telephone Number	:	210-223-3131

Provider Enumeration Date	:	07/31/2024
Last Update Date	:	03/19/2025

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Directions to “SA YOUTH ” Practice Location

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