Provider Demographics
NPI:1346600590
Name:WASHINGTON COUNTY BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:WASHINGTON COUNTY BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROJECT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:A
Authorized Official - Middle Name:
Authorized Official - Last Name:EKIBOLAJI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-217-5277
Mailing Address - Street 1:2550 RYAN ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-5883
Mailing Address - Country:US
Mailing Address - Phone:281-217-5277
Mailing Address - Fax:
Practice Address - Street 1:2550 RYAN ST
Practice Address - Street 2:SUITE B
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-5883
Practice Address - Country:US
Practice Address - Phone:281-217-5277
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-01
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)