Provider Demographics
NPI:1346433398
Name:UNITED BLACK AND BROWN
Entity Type:Organization
Organization Name:UNITED BLACK AND BROWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:DELORES
Authorized Official - Middle Name:J
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:ACSW, LMSW-ACP
Authorized Official - Phone:210-533-3433
Mailing Address - Street 1:648 DELMAR ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78210-2466
Mailing Address - Country:US
Mailing Address - Phone:210-533-3433
Mailing Address - Fax:210-533-9333
Practice Address - Street 1:648 DELMAR ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78210-2466
Practice Address - Country:US
Practice Address - Phone:210-533-3433
Practice Address - Fax:210-533-9333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)