Provider Demographics
NPI:1972053403
Name:OPEN ROADS BEHAVIORAL HEALTH PLLC
Entity Type:Organization
Organization Name:OPEN ROADS BEHAVIORAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:512-373-6280
Mailing Address - Street 1:5808 LOOKOUT MOUNTAIN DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3618
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:866-869-8828
Practice Address - Street 1:17751 PARK VALLEY DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-3592
Practice Address - Country:US
Practice Address - Phone:512-218-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33043251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health