MEDICARE: DEER OAKS MISSOURI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831354638
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEER OAKS MISSOURI

Provider Business Mailing Address
First Line	:	7272 WURZBACH RD
Second Line	:	SUITE 601
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-4801
Country	:	US
Telephone Number	:	210-615-3472
Fax Number	:	210-593-9863

Provider Business Practice Location Address
First Line	:	4741 CENTRAL ST
Second Line	:	SUITE 494
City	:	KANSAS CITY
State	:	MO
Zip	:	64112-1533
Country	:	US
Telephone Number	:	816-561-2759
Fax Number	:	210-593-9863

Authorized Official
Title or Position	:	CEO
Name	:	DR. PAUL ALAN BOSKIND
Credential	:	PH.D.
Telephone Number	:	210-615-3472

Provider Enumeration Date	:	07/22/2008
Last Update Date	:	02/05/2009

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Directions to “DEER OAKS MISSOURI ” Practice Location

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