Provider Demographics
NPI:1013627645
Name:CENTER FOR DIALECTICAL AND COGNITIVE BEHAVIORAL TH
Entity Type:Organization
Organization Name:CENTER FOR DIALECTICAL AND COGNITIVE BEHAVIORAL TH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTORNEY
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:WATT
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:210-844-0975
Mailing Address - Street 1:3308 BROADWAY STE 201
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-6549
Mailing Address - Country:US
Mailing Address - Phone:210-906-8248
Mailing Address - Fax:210-485-2477
Practice Address - Street 1:3308 BROADWAY STE 201
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-6549
Practice Address - Country:US
Practice Address - Phone:210-906-8248
Practice Address - Fax:210-485-2477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center