Provider Demographics
NPI:1588774541
Name:WEST TEXAS DEVELOPMENTAL PEDIATRIC & BEHAVORIAL HEALTH NETWORK, P.A.
Entity type:Organization
Organization Name:WEST TEXAS DEVELOPMENTAL PEDIATRIC & BEHAVORIAL HEALTH NETWORK, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BHUPALA
Authorized Official - Middle Name:RAJU
Authorized Official - Last Name:KALLEPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-281-9966
Mailing Address - Street 1:PO BOX 54136
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79453-4136
Mailing Address - Country:US
Mailing Address - Phone:806-771-1386
Mailing Address - Fax:806-771-1388
Practice Address - Street 1:3301 101ST ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-4045
Practice Address - Country:US
Practice Address - Phone:806-281-9966
Practice Address - Fax:806-281-9964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Not Answered363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0062EBOtherBCBS
TX00644NMedicare ID - Type Unspecified