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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