NPIMap

Organization Active NPI

Aeon Psychological Services PLLC

  • Psychologist
  • San Antonio, TX
National Provider Identifier
1548873227
Registry record updated Dec 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
AEON PSYCHOLOGICAL SERVICES PLLC
Practice address
921 Proton Rd
San Antonio, TX 78258-4203
Phone
(210) 551-1408
NPI assigned
Aug 24, 2020
Last updated
Dec 7, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Wade Petree, PYSDNPI 1336787753
Title
Owner
Phone
(210) 551-1408

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X NU Primary

Addresses

Primary practice location

921 Proton Rd
San Antonio, TX 78258-4203

Mailing address

921 Proton Rd
San Antonio, TX 78258-4203
Phone (210) 551-1408

Other practice location 1

510 Med Ct Ste 106
San Antonio, TX 78258-3483
Phone (210) 495-0675

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address wade@aeonpyschology.com Direct
Direct Messaging Address wadepetree@aeonpsych.org Direct

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1598227200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670371200000",
    "number": "1548873227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "921 PROTON RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782584203",
            "telephone_number": "210-551-1408"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "921 PROTON RD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782584203",
            "telephone_number": "210-551-1408"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "510 Med Ct Ste 106",
            "address_purpose": "LOCATION",
            "city": "San Antonio",
            "state": "TX",
            "postal_code": "782583483",
            "country_code": "US",
            "telephone_number": "210-495-0675",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "AEON PSYCHOLOGICAL SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-24",
        "last_updated": "2022-12-07",
        "certification_date": "2022-12-07",
        "status": "A",
        "authorized_official_last_name": "PETREE",
        "authorized_official_first_name": "WADE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "210-551-1408",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PYSD"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "wade@aeonpyschology.com",
            "affiliation": "N",
            "endpointDescription": "email",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "510 Med Ct Ste 106",
            "city": "San Antonio",
            "state": "TX",
            "country_code": "US",
            "postal_code": "782583483",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "wadepetree@aeonpsych.org",
            "affiliation": "N",
            "endpointDescription": "owner e-mail",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "921 Proton Rd",
            "city": "San Antonio",
            "state": "TX",
            "country_code": "US",
            "postal_code": "782584203",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.