Provider Demographics
NPI:1023390978
Name:CENTRAL TEXAS MHMR CENTER
Entity Type:Organization
Organization Name:CENTRAL TEXAS MHMR CENTER
Other - Org Name:CENTER FOR LIFE RESOURCES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DION
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:325-646-9574
Mailing Address - Street 1:408 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-1639
Mailing Address - Country:US
Mailing Address - Phone:325-646-9574
Mailing Address - Fax:325-646-0948
Practice Address - Street 1:408 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-1639
Practice Address - Country:US
Practice Address - Phone:325-646-9574
Practice Address - Fax:325-646-0948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX64151251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health