Provider Demographics
NPI:1689872434
Name:GERIATRIC MENTAL HEALTH SPECIALISTS, INC.
Entity Type:Organization
Organization Name:GERIATRIC MENTAL HEALTH SPECIALISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-746-7284
Mailing Address - Street 1:66 CANDLE PINE PL # 100
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-6436
Mailing Address - Country:US
Mailing Address - Phone:800-746-7284
Mailing Address - Fax:936-273-3786
Practice Address - Street 1:800 WHITLEY RD
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-2519
Practice Address - Country:US
Practice Address - Phone:817-379-0795
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-03
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX125999604Medicaid
TXCH0648OtherMEDICARE RAILROAD
TX00U08FMedicare PIN