Provider Demographics
NPI:1568630044
Name:CAN BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:CAN BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAVENAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-427-4226
Mailing Address - Street 1:401 W TEXAS AVE
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77520-4751
Mailing Address - Country:US
Mailing Address - Phone:281-427-4226
Mailing Address - Fax:
Practice Address - Street 1:401 W TEXAS AVE
Practice Address - Street 2:
Practice Address - City:BAYTOWN
Practice Address - State:TX
Practice Address - Zip Code:77520-4751
Practice Address - Country:US
Practice Address - Phone:281-427-4226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-18
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2538-A251S00000X
TX2538261QR0405X
TX2538-2538A261QR0405X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
2538-2538AOtherTEXAS DEPARTMENT OF STATE HEALTH SERVICES
TX2538-3806OtherTEXAS DEPARTMENT OF STATE HEALTH SERVICES-DSHS