Healthcare Provider Details

I. General information

NPI: 1053632505
Provider Name (Legal Business Name): AUSTIN TRAVIS COUNTY MENTAL HEALTH AND MENTAL RETARDATION CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2010
Last Update Date: 10/25/2023
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 AIRPORT BLVD
AUSTIN TX
78702-3152
US

IV. Provider business mailing address

PO BOX 3548
AUSTIN TX
78764-3548
US

V. Phone/Fax

Practice location:
  • Phone: 512-472-4357
  • Fax: 512-703-1394
Mailing address:
  • Phone: 512-441-4747
  • Fax: 512-440-4081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number3022
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number166-A
License Number StateTX

VIII. Authorized Official

Name: ZIYAD B. NUWAYHID
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 512-447-4141