Provider Demographics
NPI:1255603254
Name:TEEN HEALTH CENTER
Entity type:Organization
Organization Name:TEEN HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH LIASON
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUREL
Authorized Official - Middle Name:
Authorized Official - Last Name:MACHEN
Authorized Official - Suffix:
Authorized Official - Credentials:LMSW
Authorized Official - Phone:409-766-5713
Mailing Address - Street 1:PO BOX 925
Mailing Address - Street 2:
Mailing Address - City:GALVESTON
Mailing Address - State:TX
Mailing Address - Zip Code:77553
Mailing Address - Country:US
Mailing Address - Phone:409-766-5713
Mailing Address - Fax:409-765-5026
Practice Address - Street 1:4115 AVENUE O
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-6940
Practice Address - Country:US
Practice Address - Phone:409-766-5713
Practice Address - Fax:409-765-5026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX54955251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management