Provider Demographics
NPI:1780197491
Name:CAMINO REAL COMMUNITY MHMR CENTER
Entity Type:Organization
Organization Name:CAMINO REAL COMMUNITY MHMR CENTER
Other - Org Name:CAMINO REAL COMMUNITY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:IDD BEHAVIORAL SERVICES DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LYNNETTE
Authorized Official - Middle Name:DANIELLE
Authorized Official - Last Name:AGUILAR
Authorized Official - Suffix:
Authorized Official - Credentials:BCBA
Authorized Official - Phone:830-266-5450
Mailing Address - Street 1:19965 FM 3175
Mailing Address - Street 2:
Mailing Address - City:LYTLE
Mailing Address - State:TX
Mailing Address - Zip Code:78052-3481
Mailing Address - Country:US
Mailing Address - Phone:210-357-0300
Mailing Address - Fax:830-772-4305
Practice Address - Street 1:19965 FM 3175
Practice Address - Street 2:
Practice Address - City:LYTLE
Practice Address - State:TX
Practice Address - Zip Code:78052-3481
Practice Address - Country:US
Practice Address - Phone:210-357-0300
Practice Address - Fax:830-772-4305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty