Provider Demographics
NPI:1255069878
Name:11 11 MISSION BEHAVIORAL HEALTH PLLC
Entity type:Organization
Organization Name:11 11 MISSION BEHAVIORAL HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:SIKKEMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-722-1549
Mailing Address - Street 1:923 10TH ST STE 123
Mailing Address - Street 2:
Mailing Address - City:FLORESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78114-1870
Mailing Address - Country:US
Mailing Address - Phone:830-582-8778
Mailing Address - Fax:
Practice Address - Street 1:117 DILWORTH PLAZA
Practice Address - Street 2:
Practice Address - City:POTH
Practice Address - State:TX
Practice Address - Zip Code:78147
Practice Address - Country:US
Practice Address - Phone:830-582-8778
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty