Provider Demographics
NPI:1336206275
Name:ALAMO BEHAVIORAL HEALTH ASSOCIATES
Entity Type:Organization
Organization Name:ALAMO BEHAVIORAL HEALTH ASSOCIATES
Other - Org Name:ALAMO MENTAL HEALTH GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:BEHNKE
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:210-614-8400
Mailing Address - Street 1:4242 MEDICAL DR
Mailing Address - Street 2:SUITE 6300
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-5640
Mailing Address - Country:US
Mailing Address - Phone:210-614-8400
Mailing Address - Fax:210-614-8165
Practice Address - Street 1:4242 MEDICAL DR
Practice Address - Street 2:SUITE 6300
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-5640
Practice Address - Country:US
Practice Address - Phone:210-614-8400
Practice Address - Fax:210-614-8165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21992103TC0700X
TX23724103TC0700X
TX24459103TC0700X
TX054991041C0700X
TX101151041C0700X
TX599254363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00390TMedicare PIN