Provider Demographics
NPI:1316385149
Name:METROCARE MHMR
Entity Type:Organization
Organization Name:METROCARE MHMR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR CER
Authorized Official - Prefix:
Authorized Official - First Name:ELISA
Authorized Official - Middle Name:KERR
Authorized Official - Last Name:REES
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC
Authorized Official - Phone:214-518-9749
Mailing Address - Street 1:6035 WINDBREAK TRAIL
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75252
Mailing Address - Country:US
Mailing Address - Phone:214-518-9749
Mailing Address - Fax:
Practice Address - Street 1:1380 RIVER BEND DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247
Practice Address - Country:US
Practice Address - Phone:214-743-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-14
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63848251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX=========Medicaid