Provider Demographics
NPI:1144836412
Name:SUPPORTIVE PSYCHOLOGICAL ASSOCIATES, PLLC
Entity type:Organization
Organization Name:SUPPORTIVE PSYCHOLOGICAL ASSOCIATES, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-215-6735
Mailing Address - Street 1:5434 TIMBER TRACE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250-4442
Mailing Address - Country:US
Mailing Address - Phone:956-215-6735
Mailing Address - Fax:
Practice Address - Street 1:3740 COLONY DR STE 122
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-2290
Practice Address - Country:US
Practice Address - Phone:210-416-4238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-21
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty