Provider Demographics
NPI:1265685341
Name:CENTRAL TEXAS MHMR
Entity type:Organization
Organization Name:CENTRAL TEXAS MHMR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:GHASEM
Authorized Official - Middle Name:
Authorized Official - Last Name:NAHVIPOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-346-9574
Mailing Address - Street 1:408 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:BROWNWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76801-1639
Mailing Address - Country:US
Mailing Address - Phone:325-646-9574
Mailing Address - Fax:325-643-5136
Practice Address - Street 1:408 MULBERRY ST
Practice Address - Street 2:
Practice Address - City:BROWNWOOD
Practice Address - State:TX
Practice Address - Zip Code:76801-1639
Practice Address - Country:US
Practice Address - Phone:325-646-9574
Practice Address - Fax:325-643-5136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13184251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health