Organization
COASTAL PLAINS COMMUNITY MHMR CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEONEL TREJO (CHIEF EXECUTIVE OFFICER)
(361) 777-3991
Entity
Organization
Contact information
Practice address
200 MARRIOTT DR, PORTLAND, TX 78374-2213
(361) 777-3991
Mailing address
200 MARRIOTT DR, PORTLAND, TX 78374-2213
(361) 777-3991
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
Primary
—
—
Other
Enumeration date
12/28/2022
Last updated
02/05/2025
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