Provider Demographics
NPI:1366960106
Name:SOUTH TEXAS OCD
Entity type:Organization
Organization Name:SOUTH TEXAS OCD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:JETER
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:830-515-8480
Mailing Address - Street 1:262 N. UNION
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130
Mailing Address - Country:US
Mailing Address - Phone:830-515-8480
Mailing Address - Fax:877-310-5968
Practice Address - Street 1:262 N. UNION
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130
Practice Address - Country:US
Practice Address - Phone:830-515-8480
Practice Address - Fax:877-310-5968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-31
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty