Healthcare Provider Details

I. General information

NPI: 1154348514
Provider Name (Legal Business Name): WEST TEXAS CENTERS FOR MHMR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2006
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 W 11TH PL STE 104
BIG SPRING TX
79720-4122
US

IV. Provider business mailing address

409 RUNNELS ST
BIG SPRING TX
79720-2529
US

V. Phone/Fax

Practice location:
  • Phone: 432-263-0027
  • Fax: 432-268-9897
Mailing address:
  • Phone: 432-264-2650
  • Fax: 432-268-9897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. SHELLEY SMITH
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 432-264-2650