Organization
BLUEBONNET TRAILS COMMUNITY MHMR CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. NORALISA WILLIAMS (CREDENTIALING COORDINATOR)
(512) 244-8374
Entity
Organization
Contact information
Practice address
1009 N GEORGETOWN ST, ROUND ROCK, TX 78664-3289
(512) 255-1720
(512) 244-8371
Mailing address
1009 N GEORGETOWN ST, ROUND ROCK, TX 78664-3289
(512) 255-1720
(512) 244-8371
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
NO LICENSE
TX
133V00000X
Registered Dietitian
—
TX
171R00000X
Interpreter
—
TX
225100000X
Physical Therapist
—
TX
225X00000X
Occupational Therapist
—
TX
235Z00000X
Speech-Language Pathologist
—
TX
261QD1600X
Developmental Disabilities Clinic/Center
Primary
NO LICENSE
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1268443 03
—
TX
Enumeration date
02/12/2007
Last updated
08/28/2023
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