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

Table of content: (NPI 1114966074)

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:
02/17/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
625 W RAILROAD AVE
Provider Second Line Business Mailing Address:
#408
Provider Business Mailing Address City Name:
SHELTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98584-3522
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:
625 W RAILROAD AVE
Provider Second Line Business Practice Location Address:
#408
Provider Business Practice Location Address City Name:
SHELTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98584-3522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
682-553-8027
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 MEDICI
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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