Organization
PECAN VALLEY MHMR REGION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHELLE L LEONARD (BILLING MANAGER)
(817) 579-4400
Entity
Organization
Contact information
Practice address
2101 W PEARL ST, GRANBURY, TX 76048-1894
(817) 579-4400
Mailing address
2101 W PEARL ST, GRANBURY, TX 76048-1894
(817) 579-4400
(866) 452-5424
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
163WP0808X
Psychiatric/Mental Health Registered Nurse
—
—
2084P0800X
Psychiatry Physician
—
—
251S00000X
Community/Behavioral Health Agency
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
130724106
—
TX
Enumeration date
04/26/2007
Last updated
10/06/2023
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