NPIMap

Organization Active NPI

Autumn View Alliance, LLC

Doing business as Autumn View Alliance

  • Cognitive & Behavioral Psychologist
  • Seguin, TX
National Provider Identifier
1821283177
Registry record updated Nov 3, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X
License
11530 Issued in TX
Legal business name
AUTUMN VIEW ALLIANCE, LLC
Doing business as
Autumn View Alliance
Practice address
261 Turtle LN
Seguin, TX 78155-3142
Phone
(210) 250-1298
NPI assigned
Sep 10, 2007
Last updated
Nov 3, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2012

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

Authorized official

Name
Dr. Mary L. Trevino, PH.D.NPI 1851428957
Title
Psychologist/Manager
Phone
(210) 250-1298

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Cognitive & Behavioral Psychologist 103TB0200X 11530 TX Primary
Clinical Psychologist 103TC0700X 11530 TX
Health Service Psychologist 103TH0100X 11530 TX

Addresses

Primary practice location

261 Turtle LN
Seguin, TX 78155-3142

Mailing address

1136 E. Kingsbury St.
PMB 184
Seguin, TX 78155-2148
Phone (210) 250-1298

Other identifiers 3

IdentifierTypeStateIssuer
166851902MedicaidTX
166851903MedicaidTX
TXB101283OtherTXMEDICARE GROUP

Other names 1

  • Autumn View Alliance Doing business as

National Provider Directory

National Provider Directory

Locations

1136 E Kingsbury St
Seguin, TX 78155

131 McKinley Rd
Seguin, TX 78155
Phone (210) 250-1298

Practitioners & affiliated clinicians

Practitioners 4

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": "1189382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1351900800000",
    "number": "1821283177",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1136 E. KINGSBURY ST.",
            "address_2": "PMB 184",
            "city": "SEGUIN",
            "state": "TX",
            "postal_code": "781552148",
            "telephone_number": "210-250-1298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "261 TURTLE LN",
            "city": "SEGUIN",
            "state": "TX",
            "postal_code": "781553142",
            "telephone_number": "210-250-1298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTUMN VIEW ALLIANCE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-09-10",
        "last_updated": "2012-11-03",
        "status": "A",
        "authorized_official_last_name": "TREVINO",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "PSYCHOLOGIST/MANAGER",
        "authorized_official_telephone_number": "210-250-1298",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "TX",
            "license": "11530",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "11530",
            "primary": false
        },
        {
            "code": "103TH0100X",
            "taxonomy_group": "",
            "desc": "Psychologist, Health Service",
            "state": "TX",
            "license": "11530",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "166851902",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "166851903",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP",
            "identifier": "TXB101283",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Autumn View Alliance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Seguin, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 3, 2012; 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.