Provider Demographics
NPI:1134175763
Name:DEER OAKS MENTAL HEALTH ASSOCIATES PC
Entity type:Organization
Organization Name:DEER OAKS MENTAL HEALTH ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:BOSKIND
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:888-365-6271
Mailing Address - Street 1:7272 WURZBACH RD STE 601
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-4803
Mailing Address - Country:US
Mailing Address - Phone:888-365-6271
Mailing Address - Fax:210-615-2279
Practice Address - Street 1:5200 MARYMOUNT VILLAGE DR
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44125-2973
Practice Address - Country:US
Practice Address - Phone:888-365-6271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23669103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX084647901Medicaid
MA9762001Medicaid
VTOVN3512Medicaid
MOR880000Medicare ID - Type UnspecifiedMO MEDICARE GROUP #
IAI17335Medicare ID - Type UnspecifiedIA MEDICARE GROUP #
WYW21091Medicare PIN
MAW40047Medicare ID - Type UnspecifiedMASS. GROUP MCR #
SDS101433Medicare PIN
TX00R03TMedicare ID - Type UnspecifiedMEDICARE GROUP PROVIDER
MA9762001Medicaid