Healthcare Provider Details

I. General information

NPI: 1942340526
Provider Name (Legal Business Name): BEXAR COUNTY BOARD OF TRUSTEES FOR MHMR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8155 LONE SHADOW TRL
CONVERSE TX
78109-2436
US

IV. Provider business mailing address

6800 PARK TEN BLVD STE 200S
SAN ANTONIO TX
78213-4293
US

V. Phone/Fax

Practice location:
  • Phone: 210-659-5857
  • Fax: 210-659-7460
Mailing address:
  • Phone: 210-261-1000
  • Fax: 210-261-1821

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: EUGENE GARCIA
Title or Position: CREDENTIALING SUPERVISOR
Credential:
Phone: 210-261-1072