Provider Demographics
NPI:1649495235
Name:EAST TEXAS MENTAL HEALTH ASSOCIATES
Entity type:Organization
Organization Name:EAST TEXAS MENTAL HEALTH ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAYLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-526-7284
Mailing Address - Street 1:5620 OLD BULLARD RD
Mailing Address - Street 2:STE 111
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-4358
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5620 OLD BULLARD RD
Practice Address - Street 2:STE 111
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-4358
Practice Address - Country:US
Practice Address - Phone:903-526-7284
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX027751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0077CCMedicare ID - Type Unspecified