Provider Demographics
NPI:1295806032
Name:BEHAVIORAL WELLNESS CENTER P.A.
Entity type:Organization
Organization Name:BEHAVIORAL WELLNESS CENTER P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PEDRO
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:CHAMPION
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:956-668-0655
Mailing Address - Street 1:236 LINDBERG AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-2920
Mailing Address - Country:US
Mailing Address - Phone:956-668-0655
Mailing Address - Fax:956-668-0943
Practice Address - Street 1:236 LINDBERG AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-2920
Practice Address - Country:US
Practice Address - Phone:956-668-0655
Practice Address - Fax:956-668-0943
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH49362084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM0069970OtherDPS
TX8E0646OtherBCBS CHAMPUS
TX8E0646OtherBCBS CHAMPUS
TXB87823Medicare UPIN
TX1295806032Medicare NSC