Healthcare Provider Details

I. General information

NPI: 1639667645
Provider Name (Legal Business Name): MATAGORDA EPISCOPAL HEALTH OUTREACH PROGRAM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2018
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10119 US 59 HWY
WHARTON TX
77488-7224
US

IV. Provider business mailing address

101 AVENUE F N
BAY CITY TX
77414-3167
US

V. Phone/Fax

Practice location:
  • Phone: 979-245-2008
  • Fax: 979-217-8829
Mailing address:
  • Phone: 979-245-2008
  • Fax: 979-217-8829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: TISHA ZALMAN
Title or Position: CFO
Credential: CFO
Phone: 979-245-2008