Healthcare Provider Details

I. General information

NPI: 1750463907
Provider Name (Legal Business Name): TELECARE MENTAL HEALTH SERVICES OF TEXAS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 08/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2391 NE LOOP 410 SUITE 120
SAN ANTONIO TX
78217-5600
US

IV. Provider business mailing address

1080 MARINA VILLAGE PKWY SUITE 100
ALAMEDA CA
94501-6427
US

V. Phone/Fax

Practice location:
  • Phone: 210-222-0152
  • Fax: 210-222-1392
Mailing address:
  • Phone: 510-337-7950
  • Fax: 510-337-7969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MARSHALL LANGFELD
Title or Position: CFO, VICE PRESIDENT
Credential:
Phone: 510-337-7950