Basic Information
| Provider Information | |||||||||
| NPI: | 1134175763 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DEER OAKS MENTAL HEALTH ASSOCIATES P C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7272 WURZBACH RD STE 601 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782404803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8883656271 | ||||||||
| FaxNumber: | 2106152279 | ||||||||
| Practice Location | |||||||||
| Address1: | 7272 WURZBACH RD STE 601 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782404803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2106153483 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 10/13/2021 | ||||||||
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| AuthorizedOfficialLastName: | BOSKIND | ||||||||
| AuthorizedOfficialFirstName: | PAUL | ||||||||
| AuthorizedOfficialMiddleName: | ALAN | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8883656271 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PH.D. | ||||||||
| NPICertificationDate: | 10/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 23669 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 9762001 | 05 | MA | MEDICAID | OVN3512 | 05 | VT | MEDICAID | 084647901 | 05 | TX | MEDICAID |