Basic Information
| Provider Information | |||||||||
| NPI: | 1659943983 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | LONE STAR URGENT CARE MANAGERS, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | LITTLE SPURS AUTISM CENTERS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14100 SAN PEDRO AVE STE 608 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782324363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102818669 | ||||||||
| FaxNumber: | 2103145044 | ||||||||
| Practice Location | |||||||||
| Address1: | 24200 IH 10 W STE 109 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782571150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102639443 | ||||||||
| FaxNumber: | 2103145044 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/15/2021 | ||||||||
| LastUpdateDate: | 03/11/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | POWELL | ||||||||
| AuthorizedOfficialFirstName: | SARAH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CLINICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2102818669 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | BCBA, LBA | ||||||||
| NPICertificationDate: | 03/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Behavioral Analyst | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.