Healthcare Provider Details

I. General information

NPI: 1902265002
Provider Name (Legal Business Name): HILL COUNTRY COMMUNITY MHMR CENTER - YES WAIVER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 WATER ST STE 300
KERRVILLE TX
78028-5330
US

IV. Provider business mailing address

819 WATER ST STE 300
KERRVILLE TX
78028-5330
US

V. Phone/Fax

Practice location:
  • Phone: 830-792-3300
  • Fax: 830-792-5771
Mailing address:
  • Phone: 830-792-3300
  • Fax: 830-792-5771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: CLAYTON R MITCHELL
Title or Position: DIRECTOR OF QM/UM
Credential:
Phone: 830-792-3300