Provider Demographics
NPI:1396194825
Name:AUSTIN-TRAVIS COUNTY MENTAL HEALTH AND MENTAL RETARDATION
Entity Type:Organization
Organization Name:AUSTIN-TRAVIS COUNTY MENTAL HEALTH AND MENTAL RETARDATION
Other - Org Name:INTEGRAL CARE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORRIGAN STRICKLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-804-3203
Mailing Address - Street 1:5015 S IH 35
Mailing Address - Street 2:SUITE 200 C
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744-2713
Mailing Address - Country:US
Mailing Address - Phone:512-804-3203
Mailing Address - Fax:512-326-1287
Practice Address - Street 1:5015 S INTERSTATE 35
Practice Address - Street 2:SUITE 200 C
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-2713
Practice Address - Country:US
Practice Address - Phone:512-804-3203
Practice Address - Fax:512-326-1287
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-06
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX308133336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2160880OtherPK
TX30813OtherTEXAS BOARD OF PHARMACY