Provider Demographics
NPI:1104206853
Name:TEXAS PANHANDLE MENTAL HEALTH MENTAL RETARDATION
Entity Type:Organization
Organization Name:TEXAS PANHANDLE MENTAL HEALTH MENTAL RETARDATION
Other - Org Name:TEXAS PANHANDLE CENTERS
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELLISA
Authorized Official - Middle Name:
Authorized Official - Last Name:TALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-351-3206
Mailing Address - Street 1:901 WALLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1705
Mailing Address - Country:US
Mailing Address - Phone:806-351-3200
Mailing Address - Fax:806-351-3344
Practice Address - Street 1:901 WALLACE BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1705
Practice Address - Country:US
Practice Address - Phone:806-351-3200
Practice Address - Fax:806-351-3344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-08
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX127378105Medicaid
TX00BF18Medicare PIN