MEDICARE: BEHAVIORAL HEALTH ALLIANCE OF TEXAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1356617120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEHAVIORAL HEALTH ALLIANCE OF TEXAS

Provider Business Mailing Address
First Line	:	3015 RICHMOND AVE
Second Line	:	STE. 120-O
City	:	HOUSTON
State	:	TX
Zip	:	77098-3103
Country	:	US
Telephone Number	:	281-400-3642
Fax Number	:	281-400-3641

Provider Business Practice Location Address
First Line	:	3015 RICHMOND AVE
Second Line	:	STE. 120-O
City	:	HOUSTON
State	:	TX
Zip	:	77098-3103
Country	:	US
Telephone Number	:	281-400-3642
Fax Number	:	281-400-3641

Authorized Official
Title or Position	:	CHIEF EXECUTIVE OFFICER
Name	:	RHONDA G PATRICK
Credential	:	LCSW
Telephone Number	:	281-400-3642

Provider Enumeration Date	:	03/27/2012
Last Update Date	:	03/27/2012

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