NPIMap

Organization Active NPI

Gulf Bend MHMR Center

  • Case Management Agency
  • Victoria, TX
National Provider Identifier
1720057904
Registry record updated Aug 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Management AgencyTaxonomy code 251B00000X
Legal business name
GULF BEND MHMR CENTER
Practice address
6502 Nursery Dr
Suite100
Victoria, TX 77904-1178
Phone
(361) 575-0611
Fax
(361) 575-0626
NPI assigned
Mar 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2010

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

Authorized official

Name
Mr. Donald L Polzin
Title
Executive Director
Phone
(361) 575-0611

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X
Case Manager/Care CoordinatorGroup: 193200000X MULTI-SPECIALTY GROUP 171M00000X
Case Management Agency 251B00000X Primary
Community/Behavioral Health Agency 251S00000X

Addresses

Primary practice location

6502 Nursery Dr
Suite100
Victoria, TX 77904-1178

Mailing address

6502 Nursery Dr
Suite100
Victoria, TX 77904-1178
Phone (361) 575-0611

Other identifiers 1

IdentifierTypeStateIssuer
135254402MedicaidTX

National Provider Directory

National Provider Directory
Tax ID family
Gulf Bend MHMR Center13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

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

Locations

6502 Nursery Dr
Ste 100
Victoria, TX 77904

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": "1280793600000",
    "number": "1720057904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6502 NURSERY DR",
            "address_2": "SUITE100",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "779041178",
            "telephone_number": "361-575-0611",
            "fax_number": "361-575-0626"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6502 NURSERY DR",
            "address_2": "SUITE100",
            "city": "VICTORIA",
            "state": "TX",
            "postal_code": "779041178",
            "telephone_number": "361-575-0611",
            "fax_number": "361-575-0626"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GULF BEND MHMR CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-17",
        "last_updated": "2010-08-03",
        "status": "A",
        "authorized_official_last_name": "POLZIN",
        "authorized_official_first_name": "DONALD",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "361-575-0611",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "135254402",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Victoria, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.