Provider Demographics
NPI:1578838181
Name:ALPHA BEHAVIORAL HEALTH SERVICES
Entity Type:Organization
Organization Name:ALPHA BEHAVIORAL HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MISTY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCKNANE
Authorized Official - Suffix:
Authorized Official - Credentials:BS, LCDC, CCS, CI
Authorized Official - Phone:432-614-5720
Mailing Address - Street 1:855 CENTRAL DR STE 31B
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-4246
Mailing Address - Country:US
Mailing Address - Phone:432-614-5720
Mailing Address - Fax:877-729-4033
Practice Address - Street 1:855 CENTRAL DR STE 31B
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4246
Practice Address - Country:US
Practice Address - Phone:432-614-5720
Practice Address - Fax:877-729-4033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-14
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX11270101YA0400X, 101YA0400X
TX10857101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2813990Medicaid