Provider Demographics
NPI:1386651958
Name:PRESIDIO BEHAVIORAL HEALTH CARE SERVICES
Entity Type:Organization
Organization Name:PRESIDIO BEHAVIORAL HEALTH CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:MR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:KITSMILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-583-3300
Mailing Address - Street 1:1820 E GRIFFIN PKWY STE H
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3109
Mailing Address - Country:US
Mailing Address - Phone:956-583-3300
Mailing Address - Fax:956-583-3304
Practice Address - Street 1:1820 E GRIFFIN PKWY STE A H
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-3027
Practice Address - Country:US
Practice Address - Phone:956-583-3300
Practice Address - Fax:956-583-3304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2377-O261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder