Healthcare Provider Details

I. General information

NPI: 1124626114
Provider Name (Legal Business Name): ALAMO PREMIER MENTAL HEALTH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2020
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8546 BROADWAY STE 135
SAN ANTONIO TX
78217-6354
US

IV. Provider business mailing address

8546 BROADWAY STE 135
SAN ANTONIO TX
78217-6354
US

V. Phone/Fax

Practice location:
  • Phone: 210-940-2764
  • Fax: 830-239-9930
Mailing address:
  • Phone: 210-940-2764
  • Fax: 830-239-9930

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KOLADE AJAYI
Title or Position: OWNER
Credential:
Phone: 630-929-3034