Provider Demographics
| NPI: | 1750337259 |
|---|---|
| Name: | AUSTIN TRAVIS COUNTY MENTAL HEALTH AND MENTAL RETARDATION CENTER |
| Entity type: | Organization |
| Organization Name: | AUSTIN TRAVIS COUNTY MENTAL HEALTH AND MENTAL RETARDATION CENTER |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CHIEF MEDICAL OFFICER |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | ZIYAD |
| Authorized Official - Middle Name: | B |
| Authorized Official - Last Name: | NUWAYHID |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MD |
| Authorized Official - Phone: | 512-447-4141 |
| Mailing Address - Street 1: | 1430 COLLIER ST |
| Mailing Address - Street 2: | |
| Mailing Address - City: | AUSTIN |
| Mailing Address - State: | TX |
| Mailing Address - Zip Code: | 78704-2911 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 512-447-4141 |
| Mailing Address - Fax: | 512-440-4080 |
| Practice Address - Street 1: | 1430 COLLIER ST |
| Practice Address - Street 2: | |
| Practice Address - City: | AUSTIN |
| Practice Address - State: | TX |
| Practice Address - Zip Code: | 78704-2911 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 512-472-4357 |
| Practice Address - Fax: | 512-703-1394 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-05-26 |
| Last Update Date: | 2022-11-09 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 101YM0800X | Behavioral Health & Social Service Providers | Counselor | Mental Health | Group - Multi-Specialty |
| No | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Multi-Specialty |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 103TC2200X | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | Group - Multi-Specialty |
| No | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty | |
| No | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical | Group - Multi-Specialty |
| No | 106H00000X | Behavioral Health & Social Service Providers | Marriage & Family Therapist | Group - Multi-Specialty | |
| No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | Group - Multi-Specialty | |
| No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
| No | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | Group - Multi-Specialty | |
| No | 261QD1600X | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities | Group - Single Specialty |
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | Group - Single Specialty |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| TX | 017413801 | Other | ECI CM |
| TX | 1335424-01 | Other | MR SC |
| TX | 1335242-02 | Other | MH CM |
| TX | 00P336 | Other | BLUE CROSS BLUE SHIELD TX |
| TX | 1335424-04 | Other | MH REHAB |
| TX | 133542405 | Medicaid | |
| TX | 017413801 | Other | ECI CM |
