Organization
BLUEBONNET TRAILS MHMR CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PETER GALLIMORE (CREDENTIALING COORDINATOR)
(512) 244-8374
Entity
Organization
Contact information
Practice address
1009 N GEORGETOWN ST, ROUND ROCK, TX 78664-3289
(512) 255-1720
(512) 244-8401
Mailing address
1009 N GEORGETOWN ST, ROUND ROCK, TX 78664-3289
(512) 255-1720
(512) 244-8401
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
NO LICENSE
TX
Other
Enumeration date
02/05/2007
Last updated
08/28/2023
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