Provider Demographics
NPI:1013372374
Name:PERMIAN BASIN COMMUNITY CENTER
Entity Type:Organization
Organization Name:PERMIAN BASIN COMMUNITY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCDC
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BARTON
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC
Authorized Official - Phone:432-570-3390
Mailing Address - Street 1:502 N CARVER ST
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79701-3634
Mailing Address - Country:US
Mailing Address - Phone:432-570-3390
Mailing Address - Fax:432-570-3375
Practice Address - Street 1:502 N CARVER ST
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79701-3634
Practice Address - Country:US
Practice Address - Phone:432-570-3390
Practice Address - Fax:432-570-3375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-30
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13198251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health