Provider Demographics
NPI:1891826251
Name:CHILDRENS BEREAVEMENT CENTER OF SOUTH TEXAS
Entity type:Organization
Organization Name:CHILDRENS BEREAVEMENT CENTER OF SOUTH TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MCNAUGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC
Authorized Official - Phone:210-736-4847
Mailing Address - Street 1:332 W CRAIG PL
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-3307
Mailing Address - Country:US
Mailing Address - Phone:210-736-4847
Mailing Address - Fax:
Practice Address - Street 1:332 W CRAIG PL
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-3307
Practice Address - Country:US
Practice Address - Phone:210-736-4847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health