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75 Champions Ln San Antonio TX 78257-1281 | |
| (737) 781-3028 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 75 Champions Ln, San Antonio, Texas |
| Authorized Official Name and Position | Shavon Mariah Brooks (CEO-OWNER) |
| Authorized Official Contact | 7377813028 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 12365 Austin TX 78711-2365 Ph: (737) 781-3028 | 75 Champions Ln San Antonio TX 78257-1281 Ph: (737) 781-3028 |
| NPI Number | 1609418870 |
|---|---|
| Provider Enumeration Date | 10/09/2019 |
| Last Update Date | 01/05/2025 |
| Certification Date | 01/05/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1609418870 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
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