Provider Demographics
NPI:1013691351
Name:CENTRAL BEHAVIORAL CLINIC LLC
Entity Type:Organization
Organization Name:CENTRAL BEHAVIORAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:FATIMAH
Authorized Official - Middle Name:
Authorized Official - Last Name:THIAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-803-0408
Mailing Address - Street 1:1226 LAKEWAY CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-6146
Mailing Address - Country:US
Mailing Address - Phone:254-803-0408
Mailing Address - Fax:
Practice Address - Street 1:2919 MARKET LOOP
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1856
Practice Address - Country:US
Practice Address - Phone:254-803-0408
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty