Provider Demographics
NPI:1760509483
Name:CENTRAL TEXAS MENTAL HEALTH, LLC
Entity Type:Organization
Organization Name:CENTRAL TEXAS MENTAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:L
Authorized Official - Last Name:WOODS
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LPC-S, LSOTP
Authorized Official - Phone:979-779-2864
Mailing Address - Street 1:702 S WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77803-3985
Mailing Address - Country:US
Mailing Address - Phone:979-779-2864
Mailing Address - Fax:979-696-5577
Practice Address - Street 1:702 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77803-3985
Practice Address - Country:US
Practice Address - Phone:979-779-2864
Practice Address - Fax:979-696-5577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2011-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1609612-01Medicaid