Provider Demographics
NPI:1003372749
Name:TRINITY BEHAVIORAL HEALTH, PLLC
Entity Type:Organization
Organization Name:TRINITY BEHAVIORAL HEALTH, PLLC
Other - Org Name:TRINITY BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LCSW/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VASI
Authorized Official - Middle Name:
Authorized Official - Last Name:JANKOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-815-4468
Mailing Address - Street 1:5600 VANCE JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-3435
Mailing Address - Country:US
Mailing Address - Phone:210-815-4468
Mailing Address - Fax:
Practice Address - Street 1:5600 VANCE JACKSON RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-3435
Practice Address - Country:US
Practice Address - Phone:210-815-4468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-19
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)