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Organization

BLUEBONNET TRAILS COMMUNITY MHMR CENTER

Active
Parent organization
BLUEBONNET TRAILS COMMUNITY MHMR CENTER
Organization subpart
Yes

Provider details

NPI number
Legal business name
BLUEBONNET TRAILS COMMUNITY MHMR CENTER
Authorized official
ANDREA RICHARDSON (EXECUTIVE DIRECTOR)
(512) 244-8305
Entity
Organization

Contact information

Practice address
750 W TRAVIS ST, LA GRANGE, TX 78945-2522
(979) 968-3711
Mailing address
1009 N GEORGETOWN ST, ROUND ROCK, TX 78664-3289

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1268443-05
TX
Enumeration date
02/14/2022
Last updated
08/25/2023
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