Provider Demographics
NPI:1710342258
Name:TMHO LLC
Entity Type:Organization
Organization Name:TMHO LLC
Other - Org Name:TEXASMENTALHEALTHONLINE
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO/SOLE OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LMFT
Authorized Official - Phone:940-733-1825
Mailing Address - Street 1:4812 MAPLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-5312
Mailing Address - Country:US
Mailing Address - Phone:940-432-8631
Mailing Address - Fax:
Practice Address - Street 1:4812 MAPLEWOOD AVE # 76308
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-5312
Practice Address - Country:US
Practice Address - Phone:940-432-8631
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-29
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX357470901Medicaid