=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093624108
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MATAGORDA EPISCOPAL HEALTH OUTREACH PROGRAM CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/03/2026
-----------------------------------------------------
Last Update Date | 09/03/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 720 AVENUE F N
-----------------------------------------------------
City | BAY CITY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77414-9573
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-245-2008
-----------------------------------------------------
Fax | 979-245-0744
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 AVENUE F N
-----------------------------------------------------
City | BAY CITY
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77414-3167
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-245-2008
-----------------------------------------------------
Fax | 979-314-7164
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CFO
-----------------------------------------------------
Name | TISHA ZALMAN
-----------------------------------------------------
Credential | CFO
-----------------------------------------------------
Telephone | 979-245-2008
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------