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Organization

HEALTH AND HUMAN SERVICES COMMISSION

Active
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Organization

HEALTH AND HUMAN SERVICES COMMISSION

Active
Other names
Waco Center For Youth
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. JANA JOHNSON (ACCOUNTANT III)
(512) 206-5284
Entity
Organization

Contact information

Practice address
3501 NORTH 19TH STREET, WACO, TX 76708-2007
(245) 756-2171
(254) 745-5367
Mailing address
PO BOX 149347, AUSTIN, TX 78714-9347
(512) 458-7111
(512) 458-7588

Taxonomy

Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
TX
103TC0700X
Clinical Psychologist
TX
183500000X
Pharmacist
TX
207QA0000X
Adolescent Medicine (Family Medicine) Physician
TX
208000000X
Pediatrics Physician
TX
2084F0202X
Forensic Psychiatry Physician
TX
2084N0400X
Neurology Physician
TX
2084P0800X
Psychiatry Physician
TX
2084P0804X
Child & Adolescent 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
1099665-02
TX
05
1404444-16
TX
Enumeration date
08/15/2006
Last updated
08/25/2017
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