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Organization
GULF BEND MHMR CENTER
Active
Organization
GULF BEND MHMR CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD L POLZIN (EXECUTIVE DIRECTOR)
(361) 575-0611
Entity
Organization
Contact information
Practice address
6502 NURSERY DR, SUITE 100, VICTORIA, TX 77904-1178
(361) 575-0611
Mailing address
6502 NURSERY DR, SUITE 100, VICTORIA, TX 77904-1178
(361) 575-0611
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
NULL
101Y00000X
Counselor
—
—
101YP2500X
Professional Counselor
—
NULL
101YP2500X
Professional Counselor
—
—
171M00000X
Case Manager/Care Coordinator
Primary
—
NULL
171M00000X
Case Manager/Care Coordinator
Primary
—
—
251B00000X
Case Management Agency
—
NULL
251S00000X
Community/Behavioral Health Agency
—
NULL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135254401
—
TX
Enumeration date
03/17/2006
Last updated
08/03/2010
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