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General NPI Number Information
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NPI Number | 1013362169
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Entity Type | Organization
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Legal Business Name | TEXAS PANHANDLE MENTAL HEALTH MENTAL RETARDATION
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Dates
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Enumeration Date | 04/26/2016
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Last Update Date | 09/29/2020
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Provider Practice Location Address
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Address Line | 2002 HARDY ST
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City | AMARILLO
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State | TX
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Zip | 79106-2102
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Country | US
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Telephone | 806-351-3200
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Fax | 806-351-3344
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Provider Business Mailing Address
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Address Line | 901 WALLACE BLVD
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City | AMARILLO
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State | TX
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Zip | 79106-1705
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Country | US
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Telephone | 806-351-3200
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Fax | 806-351-3344
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MELLISA TALLEY
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Credential |
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Telephone | 806-351-3206
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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License Number | 3610-3946
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License Number State | TX
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