Provider Demographics
NPI:1578265278
Name:SLAPE, ANTHONY DREW
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:DREW
Last Name:SLAPE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 QUINLAN ST
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028
Mailing Address - Country:US
Mailing Address - Phone:830-955-3414
Mailing Address - Fax:
Practice Address - Street 1:212 QUINLAN ST
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028
Practice Address - Country:US
Practice Address - Phone:830-896-6319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-20
Last Update Date:2025-01-29
Deactivation Date:2025-01-02
Deactivation Code:
Reactivation Date:2025-01-28
Provider Licenses
StateLicense IDTaxonomies
TX1-24-78275103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst