Provider Demographics
NPI:1437485661
Name:CAN BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:CAN BEHAVIORAL HEALTH
Other - Org Name:CAN BEHAVIORAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAVENAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-526-4920
Mailing Address - Street 1:401 W TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77520-4751
Mailing Address - Country:US
Mailing Address - Phone:281-427-4226
Mailing Address - Fax:281-837-6195
Practice Address - Street 1:401 W TEXAS AVE
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-4751
Practice Address - Country:US
Practice Address - Phone:281-427-4226
Practice Address - Fax:281-837-6195
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-22
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9479101YA0400X
TX62730101YP2500X
TX059791041C0700X
TXD50672084P0802X
TXE7320208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2538-3806OtherINPATIENT/RESIDENTIAL
TX1568630044Medicaid