Provider Demographics
NPI:1679916829
Name:SOUTH TEXAS LIBERTY ALLIANCE GROUP, INC
Entity type:Organization
Organization Name:SOUTH TEXAS LIBERTY ALLIANCE GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRITTANY
Authorized Official - Middle Name:J
Authorized Official - Last Name:DODSON
Authorized Official - Suffix:
Authorized Official - Credentials:CRT
Authorized Official - Phone:210-495-2797
Mailing Address - Street 1:11202 DISCO
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-2860
Mailing Address - Country:US
Mailing Address - Phone:210-495-2797
Mailing Address - Fax:
Practice Address - Street 1:11202 DISCO
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-2860
Practice Address - Country:US
Practice Address - Phone:210-495-2797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-08
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty