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General NPI Number Information
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NPI Number | 1912296013
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Entity Type | Organization
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Legal Business Name | MHMR AUTHORITY OF BRAZOS VALLEY
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Dates
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Enumeration Date | 03/30/2011
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Last Update Date | 03/30/2011
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Provider Practice Location Address
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Address Line | 804 S TEXAS AVE
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City | BRYAN
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State | TX
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Zip | 77803-3946
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Country | US
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Telephone | 979-822-6467
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Fax | 979-821-9448
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Provider Business Mailing Address
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Address Line | PO BOX 4588
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City | BRYAN
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State | TX
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Zip | 77805-4588
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Country | US
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Telephone | 979-822-6467
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Fax | 979-821-9448
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | BILL KELLY
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Credential |
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Telephone | 979-822-6467
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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 |
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License Number State |
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