Basic Information
Provider Information | |||||||||
NPI: | 1417158817 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | TROPICAL TEXAS BEHAVIORAL HEALTH | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | TROPICAL TEXAS CENTER FOR MHMR | ||||||||
OtherOrganizationType: | 4 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1108 | ||||||||
Address2: |   | ||||||||
City: | EDINBURG | ||||||||
State: | TX | ||||||||
PostalCode: | 785401108 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9562897000 | ||||||||
FaxNumber: | 9562897025 | ||||||||
Practice Location | |||||||||
Address1: | 1901 S 24TH AVE | ||||||||
Address2: |   | ||||||||
City: | EDINBURG | ||||||||
State: | TX | ||||||||
PostalCode: | 785396533 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9562897000 | ||||||||
FaxNumber: | 9562897257 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/31/2007 | ||||||||
LastUpdateDate: | 02/03/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | PEREZ | ||||||||
AuthorizedOfficialFirstName: | AMY | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | DIRECTOR OF MANAGED CARE | ||||||||
AuthorizedOfficialTelephone: | 9562897000 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 02/03/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X |   |   | Y |   | Agencies | Community/Behavioral Health |   |
ID Information
ID | Type | State | Issuer | Description | 000395601 | 01 | TX | ICFMR HOME 2 | OTHER | 001007551 | 01 | TX | HCS CONTRACT | OTHER | 000393601 | 01 | TX | ICFMR HOME 3 | OTHER | 138708601 | 05 | TX |   | MEDICAID | 001010594 | 01 | TX | TXHML | OTHER | 000395601 | 01 | TX | ICFMR HOME 1 | OTHER | 138708613 | 05 | TX |   | MEDICAID | 138708602 | 05 | TX |   | MEDICAID | 138708611 | 05 | TX |   | MEDICAID | 138708610 | 05 | TX |   | MEDICAID |