Provider Demographics
NPI:1295270221
Name:BAY AREA REHABILITATION CENTER
Entity type:Organization
Organization Name:BAY AREA REHABILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BEHAVIORAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:REAGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WELHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:713-775-7762
Mailing Address - Street 1:7 SWALM CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77520-1411
Mailing Address - Country:US
Mailing Address - Phone:713-775-7762
Mailing Address - Fax:
Practice Address - Street 1:7 SWALM CENTER DR
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-1411
Practice Address - Country:US
Practice Address - Phone:713-775-7762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-29
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22621252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency