Provider Demographics
NPI:1922372267
Name:BEHAVIORAL SUPPORT CENTER, LLC
Entity Type:Organization
Organization Name:BEHAVIORAL SUPPORT CENTER, LLC
Other - Org Name:BSC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:R
Authorized Official - Last Name:YBARRA
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC, MAC, SAP, QASP
Authorized Official - Phone:210-526-1806
Mailing Address - Street 1:8546 BROADWAY ST
Mailing Address - Street 2:STE. 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-6376
Mailing Address - Country:US
Mailing Address - Phone:210-526-1806
Mailing Address - Fax:210-547-7984
Practice Address - Street 1:8546 BROADWAY ST BLDG C
Practice Address - Street 2:BLDG C SUITE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-6376
Practice Address - Country:US
Practice Address - Phone:210-526-1806
Practice Address - Fax:210-547-7984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-05
Last Update Date:2016-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXLCDC TX: 12124101YA0400X
103K00000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty