Provider Demographics
NPI:1841764990
Name:TRIBUE, JON KENT (BS, LCDC)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:KENT
Last Name:TRIBUE
Suffix:
Gender:M
Credentials:BS, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 W COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-3611
Mailing Address - Country:US
Mailing Address - Phone:210-434-0531
Mailing Address - Fax:
Practice Address - Street 1:3701 W COMMERCE ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-3611
Practice Address - Country:US
Practice Address - Phone:210-434-0531
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-11
Last Update Date:2019-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)