Provider Demographics
NPI:1801933361
Name:WCHS OF TEXAS
Entity type:Organization
Organization Name:WCHS OF TEXAS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OTP DIVISION PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHIL
Authorized Official - Middle Name:
Authorized Official - Last Name:HERSCHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-918-8700
Mailing Address - Street 1:700 HEMPHILL ST STE A
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3105
Mailing Address - Country:US
Mailing Address - Phone:817-334-0111
Mailing Address - Fax:817-334-0249
Practice Address - Street 1:700 HEMPHILL STREET, STE A
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3105
Practice Address - Country:US
Practice Address - Phone:918-334-0111
Practice Address - Fax:817-334-0249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0000082103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0000082OtherSTATE LICENSE NUMBER