Provider Demographics
NPI:1760555619
Name:TEXAS PANHANDLE MENTAL HEALTH MENTAL RETARDATION
Entity Type:Organization
Organization Name:TEXAS PANHANDLE MENTAL HEALTH MENTAL RETARDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MELLISA
Authorized Official - Middle Name:
Authorized Official - Last Name:TALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-351-3206
Mailing Address - Street 1:901 WALLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-1705
Mailing Address - Country:US
Mailing Address - Phone:806-358-1681
Mailing Address - Fax:
Practice Address - Street 1:901 WALLACE BLVD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-1705
Practice Address - Country:US
Practice Address - Phone:806-358-1681
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities