Healthcare Provider Details

I. General information

NPI: 1174818686
Provider Name (Legal Business Name): RGB CENTER FOR BEHAVIORAL MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2011
Last Update Date: 06/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 PECAN BLVD SUITE 5
MCALLEN TX
78501-2458
US

IV. Provider business mailing address

804 PECAN BLVD SUITE 5
MCALLEN TX
78501-2458
US

V. Phone/Fax

Practice location:
  • Phone: 956-687-4841
  • Fax: 956-585-3834
Mailing address:
  • Phone: 956-687-4841
  • Fax: 956-585-3834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: MS. IMELDA I PENA
Title or Position: MANAGER
Credential:
Phone: 956-400-4648