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General NPI Number Information
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NPI Number | 1013372374
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Entity Type | Organization
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Legal Business Name | PERMIAN BASIN COMMUNITY CENTER
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Dates
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Enumeration Date | 12/30/2015
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Last Update Date | 12/30/2015
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Provider Practice Location Address
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Address Line | 502 N CARVER ST
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City | MIDLAND
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State | TX
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Zip | 79701-3634
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Country | US
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Telephone | 432-570-3390
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Fax | 432-570-3375
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Provider Business Mailing Address
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Address Line | 502 N CARVER ST
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City | MIDLAND
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State | TX
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Zip | 79701-3634
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Country | US
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Telephone | 432-570-3390
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Fax | 432-570-3375
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Authorized Official
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Title or Position | LCDC
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Name | JENNIFER MICHELLE BARTON
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Credential | LCDC
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Telephone | 432-570-3390
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 13198
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License Number State | TX
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