Provider Demographics
NPI:1154527315
Name:BEHAVIORAL HEALTH SOLUTIONS OF SOUTH TEXAS
Entity type:Organization
Organization Name:BEHAVIORAL HEALTH SOLUTIONS OF SOUTH TEXAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:G
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:956-787-7111
Mailing Address - Street 1:5510 N. CAGE BLVD.
Mailing Address - Street 2:SUITE C
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577
Mailing Address - Country:US
Mailing Address - Phone:956-787-7111
Mailing Address - Fax:956-781-2233
Practice Address - Street 1:5510 N CAGE BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-1812
Practice Address - Country:US
Practice Address - Phone:956-787-7111
Practice Address - Fax:956-781-2233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX891-J261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1154527315Medicaid