Provider Demographics
NPI:1073894382
Name:BEHAVIORAL CLINIC
Entity Type:Organization
Organization Name:BEHAVIORAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WM.
Authorized Official - Middle Name:G
Authorized Official - Last Name:BUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-663-5500
Mailing Address - Street 1:ONE MEDICAL PLAZA
Mailing Address - Street 2:
Mailing Address - City:PAMPA
Mailing Address - State:TX
Mailing Address - Zip Code:79065-2814
Mailing Address - Country:US
Mailing Address - Phone:806-665-3721
Mailing Address - Fax:806-665-2361
Practice Address - Street 1:ONE MEDICAL PLAZA
Practice Address - Street 2:
Practice Address - City:PAMPA
Practice Address - State:TX
Practice Address - Zip Code:79065-2814
Practice Address - Country:US
Practice Address - Phone:806-665-3721
Practice Address - Fax:806-665-2361
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIGNATURE PAMPA REGIONAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0008329261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health