1114966074 NPI number — H. E. B. BEHAVIORAL MEDICINE, P. C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114966074 NPI number — H. E. B. BEHAVIORAL MEDICINE, P. C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
H. E. B. BEHAVIORAL MEDICINE, P. C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114966074
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12701 BEECH TREE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EULESS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76040-3427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
682-553-8027
Provider Business Mailing Address Fax Number:
817-571-9879

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 MIRON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHLAKE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76092-7831
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-571-2899
Provider Business Practice Location Address Fax Number:
817-571-9879
Provider Enumeration Date:
06/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TURNBULL
Authorized Official First Name:
DANA
Authorized Official Middle Name:
BETH
Authorized Official Title or Position:
PRESIDENT, H. E. B. BEHAVIORAL MEDI
Authorized Official Telephone Number:
817-571-2899

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  31454 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 352891 . This is a "MHN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 37LJ . This is a "MAGELLAN HMO BLUE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 10011985 . This is a "AMERIGROUP CLAIMS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2155975 . This is a "CIGNA BEHAVIORAL HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 195435 . This is a "AMERIGROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 224689 . This is a "TEXAS REHAB COMMISSION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00478Y . This is a "MEDICARE PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 489437 . This is a "VALUE OPTIONS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0417750-04 . This is a "TEXAS STAR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 86960A . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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