Healthcare Provider Details

I. General information

NPI: 1215353826
Provider Name (Legal Business Name): BEXAR COUNTY BOARD OF TRUSTESS FOR MENTAL HEALTH AND MENTAL RETARDATIO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2014
Last Update Date: 05/26/2023
Certification Date: 05/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N FRIO ST BLDG 2
SAN ANTONIO TX
78207-3011
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 210-246-1373
  • Fax: 210-731-9661
Mailing address:
  • Phone: 210-261-1000
  • Fax: 210-731-8678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number45D1076723
License Number StateTX

VIII. Authorized Official

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