Organization
TEXAS PANHANDLE MHMR
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELLISA TALLEY (EXECUTIVE DIRECTOR)
(806) 351-3206
Entity
Organization
Contact information
Practice address
901 WALLACE BLVD BLDG 501, AMARILLO, TX 79106-1705
(806) 351-3200
(806) 351-3344
Mailing address
901 WALLACE BLVD BLDG 501, AMARILLO, TX 79106-1705
(806) 351-3200
(806) 351-3344
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
—
TX
1041C0700X
Clinical Social Worker
—
TX
163W00000X
Registered Nurse
—
TX
2084P0800X
Psychiatry Physician
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00BF18
BLUE CROSS BLUE SHIELD
TX
01
—
A001
CHAMPUS/CHAMPVA
TX
01
—
CN4782
RAILROAD MEDICARE/UHC
TX
01
—
Z000BF188
PRIVATE INSURANCE
TX
Enumeration date
08/22/2006
Last updated
07/21/2022
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