Healthcare Provider Details

I. General information

NPI: 1013644525
Provider Name (Legal Business Name): EVIDENCE BASED BEHAVIORAL SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8626 TESORO DR STE 490
SAN ANTONIO TX
78217-6217
US

IV. Provider business mailing address

8626 TESORO DR STE 490
SAN ANTONIO TX
78217-6217
US

V. Phone/Fax

Practice location:
  • Phone: 210-202-0100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID LEE MCCLUSKEY JR.
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: PHD
Phone: 662-902-5905