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General NPI Number Information
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NPI Number | 1376869560
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Entity Type | Organization
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Legal Business Name | THE RANCH @ LA PLATA, LLC
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Dates
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Enumeration Date | 04/13/2010
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Last Update Date | 04/13/2010
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Provider Practice Location Address
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Address Line | 121 WEST FOURTH
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City | HEREFORD
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State | TX
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Zip | 79045-0000
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Country | US
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Telephone | 806-360-3784
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Fax | 806-364-5097
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Provider Business Mailing Address
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Address Line | 121 WEST FOURTH
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City | HEREFORD
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State | TX
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Zip | 79045-0000
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Country | US
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Telephone | 806-360-3784
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Fax | 806-364-5097
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Authorized Official
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Title or Position | CEO
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Name | MR. WARREN P. WALKER
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Credential | M.ED., LPC, LCDC
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Telephone | 806-292-0017
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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 | 3270-3171
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License Number State | TX
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