Provider Demographics
NPI:1760693402
Name:LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION
Entity Type:Organization
Organization Name:LUBBOCK REGIONAL MENTAL HEALTH MENTAL RETARDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DADS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:PAVLIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-766-0375
Mailing Address - Street 1:3801 AVENUE J
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79412-2017
Mailing Address - Country:US
Mailing Address - Phone:806-766-0375
Mailing Address - Fax:
Practice Address - Street 1:3801 AVENUE J
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79412-2017
Practice Address - Country:US
Practice Address - Phone:806-766-0375
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health