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General NPI Number Information
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NPI Number | 1053632505
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Entity Type | Organization
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Legal Business Name | AUSTIN TRAVIS COUNTY MENTAL HEALTH AND MENTAL RETARDATION CENTER
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Dates
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Enumeration Date | 06/18/2010
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Last Update Date | 10/25/2023
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Provider Practice Location Address
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Address Line | 1165 AIRPORT BLVD
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City | AUSTIN
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State | TX
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Zip | 78702-3152
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Country | US
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Telephone | 512-472-4357
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Fax | 512-703-1394
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Provider Business Mailing Address
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Address Line | PO BOX 3548
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City | AUSTIN
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State | TX
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Zip | 78764-3548
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Country | US
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Telephone | 512-441-4747
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Fax | 512-440-4081
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | ZIYAD B. NUWAYHID
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Credential | MD
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Telephone | 512-447-4141
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number | 3022
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License Number State | TX
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Taxonomy #2
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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 | 166-A
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License Number State | TX
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