Organization
HEALTH AND HUMAN SERVICES COMMISSION
Active
Other names
North Texas State Hospital /Wichita Falls
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JANA JOHNSON (ACCOUNTANT III)
(512) 206-5284
Entity
Organization
Contact information
Practice address
6515 KEMP BLVD, WICHITA FALLS, TX 76308-5419
(940) 689-1220
(940) 689-5784
Mailing address
4110 GUADALUPE ST, AUSTIN, TX 78751-4223
(512) 206-5011
(512) 206-5302
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
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
—
0211955-01
—
TX
05
—
0638249-01
—
TX
05
—
0827958-01
—
TX
05
—
1372468-02
—
TX
05
—
1372468-03
—
TX
05
—
1372468-04
—
TX
01
—
4538344
PHARMACY NCPDP NUMBER
TX
01
—
HH3005
BCBS DRUG/ALCOHOL
TX
01
—
HH4614
BCBS PSYCHIATRIC
TX
Enumeration date
08/17/2006
Last updated
08/25/2017
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