MEDICARE: TEXAS PANHANDLE MENTAL HEALTH MENTAL RETARDATION

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		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

General Provider Information

NPI Number	:	1912900101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEXAS PANHANDLE MENTAL HEALTH MENTAL RETARDATION

Provider Business Mailing Address
First Line	:	901 WALLACE BLVD
Second Line	:	BLDG 501
City	:	AMARILLO
State	:	TX
Zip	:	79106-1705
Country	:	US
Telephone Number	:	806-351-3200
Fax Number	:	806-351-3345

Provider Business Practice Location Address
First Line	:	901 WALLACE BLVD
Second Line	:	BLDG 501
City	:	AMARILLO
State	:	TX
Zip	:	79106-1705
Country	:	US
Telephone Number	:	806-351-3313
Fax Number	:	806-351-3345

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MELLISA TALLEY
Credential	:
Telephone Number	:	806-351-3206

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	07/21/2022

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