Organization
HEALTH AND HUMAN SERVICES COMMISSION
Active
Other names
North Texas State Hospital/Vernon
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTY CARR (ASSOCIATE COMMISSIONER)
(512) 814-6942
Entity
Organization
Contact information
Practice address
4730 COLLEGE DRIVE, VERNON, TX 76384-4009
(940) 552-9901
(940) 553-2523
Mailing address
4110 GUADALUPE ST, MC-2023, AUSTIN, TX 78751-4296
(512) 206-5284
(512) 206-5302
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
—
—
103T00000X
Psychologist
—
TX
103TC0700X
Clinical Psychologist
—
TX
103TF0200X
Forensic Psychologist
—
TX
183500000X
Pharmacist
—
TX
2084F0202X
Forensic Psychiatry Physician
—
TX
2084P0800X
Psychiatry Physician
—
TX
2084P0804X
Child & Adolescent Psychiatry Physician
—
TX
2084P0805X
Geriatric Psychiatry Physician
—
TX
208D00000X
General Practice Physician
—
TX
363A00000X
Physician Assistant
—
TX
363L00000X
Nurse Practitioner
—
TX
364S00000X
Clinical Nurse Specialist
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0211963-01
—
TX
05
—
1081036-01
—
TX
05
—
1081036-02
—
TX
05
—
1301640-07
—
TX
01
—
4539219
PHARMACY NCPDP NUMBER
TX
01
—
HH3011
BCBS ADOLESCENT
TX
01
—
HH4008
BCBS FORENSIC
TX
Enumeration date
09/08/2006
Last updated
02/22/2024
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