Provider Demographics
NPI:1104123926
Name:MCLENNAN COUNTY
Entity type:Organization
Organization Name:MCLENNAN COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR (CHIEF PROBATION OFFICER)
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPOS
Authorized Official - Suffix:
Authorized Official - Credentials:BSW
Authorized Official - Phone:254-757-5072
Mailing Address - Street 1:2601 GHOLSON RD
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76704-1106
Mailing Address - Country:US
Mailing Address - Phone:254-757-5072
Mailing Address - Fax:254-799-4902
Practice Address - Street 1:2601 GHOLSON RD
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76704-1106
Practice Address - Country:US
Practice Address - Phone:254-757-5072
Practice Address - Fax:254-799-4902
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MCLENNAN COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19676104100000X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty