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General NPI Number Information
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NPI Number | 1295270221
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Entity Type | Organization
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Legal Business Name | BAY AREA REHABILITATION CENTER
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Dates
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Enumeration Date | 12/29/2016
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Last Update Date | 12/29/2016
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Provider Practice Location Address
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Address Line | 7 SWALM CENTER DR
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City | BAYTOWN
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State | TX
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Zip | 77520-1411
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Country | US
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Telephone | 713-775-7762
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Fax |
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Provider Business Mailing Address
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Address Line | 7 SWALM CENTER DR
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City | BAYTOWN
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State | TX
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Zip | 77520-1411
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Country | US
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Telephone | 713-775-7762
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Fax |
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Authorized Official
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Title or Position | BEHAVIORAL THERAPIST
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Name | REAGAN WELHAM
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Credential | LCSW
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Telephone | 713-775-7762
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 22621
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License Number State | TX
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