Basic Information
| Provider Information | |||||||||
| NPI: | 1871576835 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLLIN COUNTY MENTAL HEALTH MENTAL RETARDATION CENTER | ||||||||
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| OtherOrganizationName: | COLLIN COUNTY MHMR CENTER | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1515 HERITAGE DR STE 105 | ||||||||
| Address2: | |||||||||
| City: | MCKINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750693378 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725620190 | ||||||||
| FaxNumber: | 9725623647 | ||||||||
| Practice Location | |||||||||
| Address1: | 1515 HERITAGE DR | ||||||||
| Address2: | 105 | ||||||||
| City: | MCKINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750693256 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9725620190 | ||||||||
| FaxNumber: | 9726650076 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2005 | ||||||||
| LastUpdateDate: | 11/22/2021 | ||||||||
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| AuthorizedOfficialLastName: | PUTMAN | ||||||||
| AuthorizedOfficialFirstName: | MARIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | HUMAN RESOURCE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9725620190 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | 225100000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 225X00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | 235Z00000X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | 251B00000X | TX | N | Agencies | Case Management | 261QD1600X | TX | N | Ambulatory Health Care Facilities | Clinic/Center | Developmental Disabilities | 101Y00000X | TX | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | 101YM0800X | TX | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical | 106H00000X | TX | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 2084P0800X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 261QR0405X | 3274 -3276 | TX | N | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | 320600000X | N | Residential Treatment Facilities | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 261QM0801X | TX | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
ID Information
| ID | Type | State | Issuer | Description | 001010100 | 01 | TX | TXHML | OTHER | 084001901 | 05 | TX | MEDICAID | 127377306 | 05 | TX | MEDICAID | GR410 | 01 | TX | GR-SERVICE COORDINATION | OTHER | 001007092 | 01 | TX | HCS | OTHER | 127377304 | 05 | TX | MEDICAID | 127377305 | 05 | TX | MEDICAID | 127377302 | 05 | TX | MEDICAID | 000730601 | 01 | TX | ICF-MR-MULLINS | OTHER | 00726901 | 01 | TX | ICF-MR-CROSS BEND | OTHER | 127377301 | 05 | TX | MEDICAID |