Provider Demographics
NPI:1801020995
Name:DENTON COUNTY MHMR CENTER
Entity Type:Organization
Organization Name:DENTON COUNTY MHMR CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PAM
Authorized Official - Middle Name:
Authorized Official - Last Name:GUTIERREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-565-5260
Mailing Address - Street 1:PO BOX 2346
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76202-2346
Mailing Address - Country:US
Mailing Address - Phone:940-381-5000
Mailing Address - Fax:940-382-3707
Practice Address - Street 1:2519 SCRIPTURE ST
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-2324
Practice Address - Country:US
Practice Address - Phone:940-381-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-05
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135234604Medicaid
TX135234601Medicaid
TX135234602Medicaid