Provider Demographics
NPI:1588489470
Name:BERTRAND, DEJA
Entity type:Individual
Prefix:
First Name:DEJA
Middle Name:
Last Name:BERTRAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1810 E SONTERRA BLVD APT 4113
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-7629
Mailing Address - Country:US
Mailing Address - Phone:832-616-8202
Mailing Address - Fax:
Practice Address - Street 1:8627 CINNAMON CREEK DR STE 601
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-1482
Practice Address - Country:US
Practice Address - Phone:210-725-1039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX97114101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health