Provider Demographics
NPI:1548692502
Name:NIZHONI BEHAVIORAL HEALTH CENTER
Entity type:Organization
Organization Name:NIZHONI BEHAVIORAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:C
Authorized Official - Last Name:STORM
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:325-716-1185
Mailing Address - Street 1:3814 SHERWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-3539
Mailing Address - Country:US
Mailing Address - Phone:325-716-1185
Mailing Address - Fax:325-480-0456
Practice Address - Street 1:3814 SHERWOOD WAY
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-3539
Practice Address - Country:US
Practice Address - Phone:325-716-1185
Practice Address - Fax:325-480-0456
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty