Provider Demographics
NPI:1932184389
Name:FAMILY BEHAVIORAL HEALTH ASSOCIATES
Entity Type:Organization
Organization Name:FAMILY BEHAVIORAL HEALTH ASSOCIATES
Other - Org Name:COUNSELING AND TESTING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLAIM
Authorized Official - Middle Name:WALTER
Authorized Official - Last Name:COFIELD
Authorized Official - Suffix:JR
Authorized Official - Credentials:PSYD
Authorized Official - Phone:254-699-7222
Mailing Address - Street 1:P.O. BOX 938
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76540
Mailing Address - Country:US
Mailing Address - Phone:254-699-7222
Mailing Address - Fax:512-556-2188
Practice Address - Street 1:4520 E CENTRAL TEXAS EXPY
Practice Address - Street 2:SUITE 111
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543-5626
Practice Address - Country:US
Practice Address - Phone:254-699-7222
Practice Address - Fax:512-556-2188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-08
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX24153103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX66198OtherTEXAS DEPT OF HEALTH CSHC
TX00U51UOtherBCBS OF TEXAS
TX085678301Medicaid
TX66198OtherTEXAS DEPT OF HEALTH CSHC