1740343946 NPI number — BEACON MENTAL HEALTH & SOCIAL SERVICES

Table of content: (NPI 1740343946)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740343946 NPI number — BEACON MENTAL HEALTH & SOCIAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEACON MENTAL HEALTH & SOCIAL SERVICES
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:
1740343946
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5726 SAGAMORE BAY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77469-7398
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-248-4636
Provider Business Mailing Address Fax Number:
866-804-7241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 WAVERLY ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77008-6760
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-248-4636
Provider Business Practice Location Address Fax Number:
866-804-7241
Provider Enumeration Date:
12/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HOUSEWORTH
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
832-248-4636

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X , with the licence number: 31626 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X , with the licence number: 5210 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0805X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1732695-07 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".