Provider Demographics
NPI:1104143031
Name:ST. MADISON COMMUNITY MENTAL HEALTH CENTER INC
Entity type:Organization
Organization Name:ST. MADISON COMMUNITY MENTAL HEALTH CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-206-8454
Mailing Address - Street 1:4410 PEACHAM LN
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:TX
Mailing Address - Zip Code:77545-9696
Mailing Address - Country:US
Mailing Address - Phone:832-206-8454
Mailing Address - Fax:
Practice Address - Street 1:11214 FREESTONE AVE
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-5518
Practice Address - Country:US
Practice Address - Phone:832-206-8454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-03
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty