Provider Demographics
NPI:1386778405
Name:GERIATRIC MENTAL HEALTH SPECIALISTS INC.
Entity type:Organization
Organization Name:GERIATRIC MENTAL HEALTH SPECIALISTS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:ORTEGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-273-3786
Mailing Address - Street 1:66 CANDLE PINE PL
Mailing Address - Street 2:#100
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-6436
Mailing Address - Country:US
Mailing Address - Phone:936-273-3786
Mailing Address - Fax:
Practice Address - Street 1:2504 BLISS SPILLAR RD
Practice Address - Street 2:
Practice Address - City:MANCHACA
Practice Address - State:TX
Practice Address - Zip Code:78652-4409
Practice Address - Country:US
Practice Address - Phone:512-282-3723
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-14
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX125999603Medicaid
TX125999603Medicaid