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1881621225

NPI Code Detail

MEDICARE: MHMRA OF BRAZOS VALLEY

MEDICARE: MHMRA OF BRAZOS VALLEY

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1881621225
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MHMRA OF BRAZOS VALLEY

Provider Business Mailing Address
First Line	:	1504 TEXAS AVE.
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77805-1504
Country	:	US
Telephone Number	:	979-822-6467
Fax Number	:	979-821-9448

Provider Business Practice Location Address
First Line	:	804 S TEXAS AVE
Second Line	:
City	:	BRYAN
State	:	TX
Zip	:	77803-3946
Country	:	US
Telephone Number	:	979-822-6467
Fax Number	:	979-821-9448

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. BILL KELLY
Credential	:
Telephone Number	:	979-822-6467

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	03/26/2024

Similar Medicare Providers

1912296013 — MHMR AUTHORITY OF BRAZOS VALLEY
Practice Location Address:

804 S TEXAS AVE
BRYAN, TX
77803-3946

Practice Phone: 979-822-6467
Practice Fax: 979-821-9448

1396166245 — GREGORY BRIGANDO LPC
Practice Location Address:

804 S TEXAS AVE
BRYAN, TX
77803-3946

Practice Phone: 979-361-9815
Practice Fax:

1760935720 — MHMR AUTHORITY OF BRAZOS VALLEY
Practice Location Address:

804 S TEXAS AVE
BRYAN, TX
77803-3946

Practice Phone: 979-220-2881
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1477060655 — DR. JESSICA LYNNE HALL PH.D.
Practice Location Address:

804 S TEXAS AVE
BRYAN, TX
77803-3946

Practice Phone: 979-822-6467
Practice Fax:

1174030357 — MRS. DIANA HOFSTETTER LPC
Practice Location Address:

804 S TEXAS AVE
BRYAN, TX
77803-3946

Practice Phone: 979-361-9851
Practice Fax:

1205323722 — ELIZABETH BOGGESS LPC
Practice Location Address:

804 S TEXAS AVE
BRYAN, TX
77803-3946

Practice Phone: 979-361-1273
Practice Fax:

Directions to “MHMRA OF BRAZOS VALLEY ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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