Provider Demographics
| NPI: | 1992708705 |
|---|---|
| Name: | LUBBOCK REGIONAL MHMR CENTER |
| Entity type: | Organization |
| Organization Name: | LUBBOCK REGIONAL MHMR CENTER |
| Other - Org Name: | <UNAVAIL> |
| Other - Org Type: | |
| Authorized Official - Title/Position: | CEO |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | BETH |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | LAWSON |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 806-767-1648 |
| Mailing Address - Street 1: | PO BOX 2828 |
| Mailing Address - Street 2: | |
| Mailing Address - City: | LUBBOCK |
| Mailing Address - State: | TX |
| Mailing Address - Zip Code: | 79408-2828 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 806-766-0310 |
| Mailing Address - Fax: | 806-766-0250 |
| Practice Address - Street 1: | 1950 ASPEN AVE |
| Practice Address - Street 2: | |
| Practice Address - City: | LUBBOCK |
| Practice Address - State: | TX |
| Practice Address - Zip Code: | 79404-1211 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 806-766-0213 |
| Practice Address - Fax: | |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2005-05-24 |
| Last Update Date: | 2024-07-03 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 261Q00000X | Ambulatory Health Care Facilities | Clinic/Center | ||
| No | 171M00000X | Other Service Providers | Case Manager/Care Coordinator | Group - Single Specialty | |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Single Specialty |
| No | 251B00000X | Agencies | Case Management | ||
| No | 251T00000X | Agencies | Program of All-Inclusive Care for the Elderly (PACE) Provider Organization | ||
| No | 261QM0801X | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | |
| No | 261QM0850X | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health | |
| No | 261QM0855X | Ambulatory Health Care Facilities | Clinic/Center | Adolescent and Children Mental Health | |
| No | 261QM2800X | Ambulatory Health Care Facilities | Clinic/Center | Methadone | |
| No | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care | Group - Single Specialty |
| No | 261QR0405X | Ambulatory Health Care Facilities | Clinic/Center | Rehabilitation, Substance Use Disorder | Group - Single Specialty |
| No | 283Q00000X | Hospitals | Psychiatric Hospital | Group - Single Specialty | |
| No | 315P00000X | Nursing & Custodial Care Facilities | Intermediate Care Facility, Intellectual Disabilities | Group - Single Specialty | |
| No | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | Group - Single Specialty | |
| No | 363LP2300X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | Group - Single Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| TX | 0848970-01 | Medicaid | |
| TX | 001018313 | Medicaid | |
| TX | 1364929-03 | Medicaid | |
| TX | 1364929-09 | Medicaid | |
| TX | 1364929-01 | Medicaid | |
| TX | 1364929-11 | Medicaid | |
| TX | 1D9349 | Other | MEDICARE B OTP |
| TX | 1364929-07 | Medicaid | |
| TX | 1364929-08 | Medicaid |
