NPIMap

Organization Active NPI

STBM LLC

Doing business as South Texas Behavioral Medicine

  • Clinical Psychologist
  • San Antonio, TX
National Provider Identifier
1992921019
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
22545 Issued in TX
Legal business name
STBM LLC
Doing business as
South Texas Behavioral Medicine
Practice address
12050 Vance Jackson
BLDG. 2, Ste. 201
San Antonio, TX 78230-1183
Phone
(210) 699-8881
Fax
(210) 699-0503
NPI assigned
Apr 17, 2007
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
Yes
Parent organization
STBM LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mrs. Diane Pena
Title
Office Manager
Phone
(210) 699-8881

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 103TC0700X 22545 TX Primary
Marriage & Family TherapistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 106H00000X 1884 TX

Addresses

Primary practice location

12050 Vance Jackson
BLDG. 2, Ste. 201
San Antonio, TX 78230-1183

Mailing address

12050 Vance Jackson
BLDG. 2, Ste. 201
San Antonio, TX 78230-1183
Phone (210) 699-8881

Other identifiers 8

IdentifierTypeStateIssuer
1306857966OtherTXMD
1174549109OtherTXMD
1851317895OtherTXLMFT, PHD, LPC
1124053632OtherTXAPRN, MSN, BC
1760408702OtherTXMD
1427064062OtherTXMD
1295743706OtherTXPHD
1487689998OtherTXLPC, PHD

Other names 1

  • South Texas Behavioral Medicine Doing business as

National Provider Directory

National Provider Directory
Part of
STBM LLC

Locations

12050 Vance Jackson Rd
Ste 201
San Antonio, TX 78230
Phone (210) 699-8881

Practitioners & affiliated clinicians

Practitioners 11

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": "1176768000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1992921019",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12050 VANCE JACKSON",
            "address_2": "BLDG. 2, STE. 201",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782301183",
            "telephone_number": "210-699-8881",
            "fax_number": "210-699-0503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12050 VANCE JACKSON",
            "address_2": "BLDG. 2, STE. 201",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782301183",
            "telephone_number": "210-699-8881",
            "fax_number": "210-699-0503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STBM LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STBM LLC",
        "enumeration_date": "2007-04-17",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "PENA",
        "authorized_official_first_name": "DIANE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "210-699-8881",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "22545",
            "primary": true
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": "TX",
            "license": "1884",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD",
            "identifier": "1306857966",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD",
            "identifier": "1174549109",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LMFT, PHD, LPC",
            "identifier": "1851317895",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "APRN, MSN, BC",
            "identifier": "1124053632",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD",
            "identifier": "1760408702",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MD",
            "identifier": "1427064062",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHD",
            "identifier": "1295743706",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LPC, PHD",
            "identifier": "1487689998",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "South Texas Behavioral Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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 Jul 21, 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.