1124313804 NPI number — EL CENTRO DEL BARRIO, INC

Table of content: MR. CORBY CASEY MA LMHC (NPI 1386804003)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124313804 NPI number — EL CENTRO DEL BARRIO, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EL CENTRO DEL BARRIO, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124313804
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3750 COMMERCIAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78221-3117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-334-3700
Provider Business Mailing Address Fax Number:
210-922-0162

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3127 SE MILITARY DR
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78223-3990
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-928-4970
Provider Business Practice Location Address Fax Number:
210-928-4999
Provider Enumeration Date:
06/10/2011

Additional Information

Authorized Official

Authorized Official Last Name:
WALZEL
Authorized Official First Name:
CHUCK
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
210-334-3724

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 120980102 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 120980101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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