# BLUEBONNET TRAILS COMMUNITY MHMR CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023150877
- **Authorized official:** MS. NORALISA WILLIAMS (CREDENTIALING COORDINATOR)
- **Authorized official phone:** (512) 244-8374

## Contact information

- **Practice address:** 1009 N GEORGETOWN ST, ROUND ROCK, TX 78664-3289
- **Practice address phone:** (512) 255-1720
- **Practice address fax:** (512) 244-8371
- **Mailing address:** 1009 N GEORGETOWN ST, ROUND ROCK, TX 78664-3289
- **Mailing address phone:** (512) 255-1720
- **Mailing address fax:** (512) 244-8371

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 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 | NO LICENSE | TX | Yes |
| 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

- **Enumeration date:** 02/12/2007
- **Last updated:** 08/28/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0197201 01 | — | TX |
| 05 | — | 1268443 02 | — | TX |
| 05 | — | 1268443 04 | — | TX |
| 05 | — | 1268443 05 | — | TX |