Organization
CENTRAL COUNTIES CENTER FOR MENTAL HEALTH & MENTAL RETARDATION SRVS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHNNETTE WARDELL (EXECUTIVE DIRECTOR)
(254) 298-7007
Entity
Organization
Contact information
Practice address
304 S 22ND ST, TEMPLE, TX 76501-4726
(254) 298-7000
Mailing address
304 S 22ND ST, TEMPLE, TX 76501-4726
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
Primary
—
—
1041C0700X
Clinical Social Worker
—
—
171M00000X
Case Manager/Care Coordinator
—
—
251B00000X
Case Management Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
029168401
—
TX
05
—
081771001
—
TX
05
—
121984201
—
TX
05
—
121984202
—
TX
05
—
151116401
—
TX
Enumeration date
03/17/2006
Last updated
02/10/2022
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