Organization
AUSTIN TRAVIS COUNTY MHMR CENTER
Active
Other names
ATCMHMR ECI Case Management
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAMES RUSSEL VAN NORMAN M.D. (MEDICAL DIRECTOR)
(512) 440-4021
Entity
Organization
Contact information
Practice address
1717 W 10TH ST, AUSTIN, TX 78703-3907
(512) 804-3100
(512) 472-3103
Mailing address
PO BOX 3548, AUSTIN, TX 78764-3548
(512) 445-7787
(512) 440-4059
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00P336
BLUE CROSS BLUE SHIELD
TX
Enumeration date
02/27/2007
Last updated
08/22/2020
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