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General NPI Number Information
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NPI Number | 1386651958
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Entity Type | Organization
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Legal Business Name | PRESIDIO BEHAVIORAL HEALTH CARE SERVICES
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1820 E GRIFFIN PKWY STE A H
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City | MISSION
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State | TX
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Zip | 78572-3027
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Country | US
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Telephone | 956-583-3300
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Fax | 956-583-3304
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Provider Business Mailing Address
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Address Line | 1820 E GRIFFIN PKWY STE H
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City | MISSION
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State | TX
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Zip | 78572-3109
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Country | US
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Telephone | 956-583-3300
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Fax | 956-583-3304
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Authorized Official
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Title or Position | LPC
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Name | MR. TODD KITSMILLER
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Credential |
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Telephone | 956-583-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 2377-O
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License Number State | TX
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