NPIMap

Organization Active NPI

Central Counties Center for Mental Health & Mental Retardation SRVS

  • Mental Health Counselor
  • Temple, TX
National Provider Identifier
1356310585
Registry record updated Feb 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
CENTRAL COUNTIES CENTER FOR MENTAL HEALTH & MENTAL RETARDATION SRVS
Practice address
304 S 22ND St
Temple, TX 76501-4726
Phone
(254) 298-7000
NPI assigned
Mar 17, 2006
Last updated
Feb 10, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 10, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Johnnette Wardell
Title
Executive Director
Phone
(254) 298-7007

Specialties & licenses 6

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X NU
Mental Health Counselor 101YM0800X NU Primary
Clinical Social Worker 1041C0700X NU
Case Management Agency 251B00000X NU
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X NU
Case Manager/Care Coordinator 171M00000X NU

Addresses

Primary practice location

304 S 22ND St
Temple, TX 76501-4726

Mailing address

304 S 22ND St
Temple, TX 76501-4726

Other identifiers 5

IdentifierTypeStateIssuer
081771001MedicaidTX
029168401MedicaidTX
121984201MedicaidTX
151116401MedicaidTX
121984202MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040803000542 TX Part B Supplier - Clinic/Group Practice 1658341359 Receives reassigned benefits from 46 practitioners
1 other NPI on this enrollment
Practice locations: Cameron, TX; Temple, TX; Rockdale, TX; Lampasas, TX; Killeen, TX; Hamilton, TX; Gatesville, TX; Copperas Cove, TX

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
Center Counties Services4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

304 S 22nd St
Temple, TX 76501
Phone (254) 298-7000

Practitioners & affiliated clinicians

Practitioners 48

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 48

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1644451200000",
    "number": "1356310585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 S 22ND ST",
            "city": "TEMPLE",
            "state": "TX",
            "postal_code": "765014726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 S 22ND ST",
            "city": "TEMPLE",
            "state": "TX",
            "postal_code": "765014726",
            "telephone_number": "254-298-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL COUNTIES CENTER FOR MENTAL HEALTH & MENTAL RETARDATION SRVS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-17",
        "last_updated": "2022-02-10",
        "certification_date": "2022-02-10",
        "status": "A",
        "authorized_official_last_name": "WARDELL",
        "authorized_official_first_name": "JOHNNETTE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "254-298-7007"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "081771001",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "029168401",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121984201",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "151116401",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121984202",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Temple, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.