Provider Demographics
NPI:1154348514
Name:WEST TEXAS CENTERS FOR MHMR
Entity type:Organization
Organization Name:WEST TEXAS CENTERS FOR MHMR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:432-264-2650
Mailing Address - Street 1:409 RUNNELS ST
Mailing Address - Street 2:
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-2529
Mailing Address - Country:US
Mailing Address - Phone:432-264-2650
Mailing Address - Fax:432-268-9897
Practice Address - Street 1:1501 W 11TH PL STE 104
Practice Address - Street 2:
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-4122
Practice Address - Country:US
Practice Address - Phone:432-263-0027
Practice Address - Fax:432-268-9897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX130725806Medicaid