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Organization
BLUEBONNET TRAILS COMMUNITY MHMR CENTER
Active
Organization
BLUEBONNET TRAILS COMMUNITY MHMR CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. NORALISA WILLIAMS (CREDENTIALING COORDINATOR)
(512) 244-8374
Entity
Organization
Contact information
Practice address
1009 N GEORGETOWN ST, ROUND ROCK, TX 78664-3289
(512) 255-1720
(512) 244-8371
Mailing address
1009 N GEORGETOWN ST, ROUND ROCK, TX 78664-3289
(512) 255-1720
(512) 244-8371
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
NO LICENSE
TX
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
NO LICESE
TX
164X00000X
Licensed Vocational Nurse
NO LICENSE
TX
171M00000X
Case Manager/Care Coordinator
Primary
NO LICENSE
TX
171R00000X
Interpreter
NO LICENSE
TX
2084P0800X
Psychiatry Physician
NO LICENSE
TX
363LA2200X
Adult Health Nurse Practitioner
NO LICENSE
TX
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
NO LICENSE
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0197201 01
—
TX
05
—
1268443 02
—
TX
05
—
1268443 04
—
TX
05
—
1268443 05
—
TX
Enumeration date
02/12/2007
Last updated
08/28/2023
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