Healthcare Provider Details

I. General information

NPI: 1336206275
Provider Name (Legal Business Name): ALAMO BEHAVIORAL HEALTH ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4242 MEDICAL DR SUITE 6300
SAN ANTONIO TX
78229-5640
US

IV. Provider business mailing address

4242 MEDICAL DR SUITE 6300
SAN ANTONIO TX
78229-5640
US

V. Phone/Fax

Practice location:
  • Phone: 210-614-8400
  • Fax: 210-614-8165
Mailing address:
  • Phone: 210-614-8400
  • Fax: 210-614-8165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number23724
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number24459
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number21992
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number05499
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10115
License Number StateTX
# 6
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number599254
License Number StateTX

VIII. Authorized Official

Name: MS. DIANE BEHNKE CASTILLO
Title or Position: VICE PRESIDENT
Credential: LCSW
Phone: 210-614-8400