Prairie Harbor, LLC
Organization Active NPI Emotionally Disturbed Childrens' Residential Treatment Facility · Wallis, TX
NPI 1235565797 · NPPES record last updated Feb 28, 2014
Key facts
- NPI
- 1235565797
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Emotionally Disturbed Childrens' Residential Treatment Facility 322D00000X
- Legal business name
- PRAIRIE HARBOR, LLC
- Practice address
- 7146 Highway 60
Wallis, TX 77485-9507 - Phone
- (979) 217-1581
- NPI assigned
- Sep 16, 2013
- Organization subpart
- No
Authorized official
- Name
- Randall Bryant
- Title
- Executive Director
- Phone
- (979) 217-1581
Practitioners 5
-
Luz Alquicira, LCSW, LCDC, ASOTP
-
Lindsey Bartay, LPC
-
Brett Bergvall, LPC
-
Melanie Renee Graybill, LCSW
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emotionally Disturbed Childrens' Residential Treatment Facility | 322D00000X | Yes |
Addresses
Primary practice location
7146 Highway 60
Wallis, TX 77485-9507
Mailing address
PO Box 517
Wallis, TX 77485-0517
Other providers in Wallis, TX
- Comprehensive Counseling
- Susie Cone
- Melanie Renee Graybill
- Jennifer Lindley
- Gay Minks
- Noreen Marie Rojas
- Elizabeth Thompson
- Geralyn Tipton
- Rosemary Trevino
- Wallis Wellness PLLC
All providers in Wallis, TX · Emotionally Disturbed Childrens' Residential Treatment Facility in Texas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 28, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.