Organization
GULF BEND MHMR CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DONALD L POLZIN (EXECUTIVE DIRECTOR)
(361) 575-0611
Entity
Organization
Contact information
Practice address
6502 NURSERY DR, SUITE 100, VICTORIA, TX 77904-1178
(361) 575-0611
(361) 575-0626
Mailing address
6502 NURSERY DR, SUITE 100, VICTORIA, TX 77904-1178
(361) 575-0611
(361) 575-0626
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135254405
—
TX
Enumeration date
03/17/2006
Last updated
08/03/2010
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