Provider Demographics
NPI:1053632505
Name:AUSTIN TRAVIS COUNTY MENTAL HEALTH AND MENTAL RETARDATION CENTER
Entity Type:Organization
Organization Name:AUSTIN TRAVIS COUNTY MENTAL HEALTH AND MENTAL RETARDATION CENTER
Other - Org Name:INTEGRAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ZIYAD
Authorized Official - Middle Name:B
Authorized Official - Last Name:NUWAYHID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-447-4141
Mailing Address - Street 1:PO BOX 3548
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78764-3548
Mailing Address - Country:US
Mailing Address - Phone:512-441-4747
Mailing Address - Fax:512-440-4081
Practice Address - Street 1:1165 AIRPORT BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-3152
Practice Address - Country:US
Practice Address - Phone:512-472-4357
Practice Address - Fax:512-703-1394
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-18
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX166-A261QR0405X
TX3022324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX212084201Medicaid