Provider Demographics
NPI:1992921019
Name:STBM LLC
Entity type:Organization
Organization Name:STBM LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:PENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-699-8881
Mailing Address - Street 1:12050 VANCE JACKSON
Mailing Address - Street 2:BLDG. 2, STE. 201
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1183
Mailing Address - Country:US
Mailing Address - Phone:210-699-8881
Mailing Address - Fax:210-699-0503
Practice Address - Street 1:12050 VANCE JACKSON
Practice Address - Street 2:BLDG. 2, STE. 201
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-1183
Practice Address - Country:US
Practice Address - Phone:210-699-8881
Practice Address - Fax:210-699-0503
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STBM LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22545103TC0700X
TX1884106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1306857966OtherMD
TX1174549109OtherMD
TX1851317895OtherLMFT, PHD, LPC
TX1124053632OtherAPRN, MSN, BC
TX1760408702OtherMD
TX1427064062OtherMD
TX1295743706OtherPHD
TX1487689998OtherLPC, PHD