Provider Demographics
NPI:1740469634
Name:WEST TEXAS TREATMENT CENTER
Entity type:Organization
Organization Name:WEST TEXAS TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/LPC
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MARCEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-613-0030
Mailing Address - Street 1:1790 N LEE TREVINO DR
Mailing Address - Street 2:#203
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-4545
Mailing Address - Country:US
Mailing Address - Phone:915-613-0030
Mailing Address - Fax:915-594-7101
Practice Address - Street 1:1790 N LEE TREVINO DR
Practice Address - Street 2:#203
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-4545
Practice Address - Country:US
Practice Address - Phone:915-613-0030
Practice Address - Fax:915-594-7101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18932251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB1048075 UPINOtherBLUE CROSS/BLUE SHIELD