Austin Travis County Mental Health and Mental Retardation Center
Organization Active NPI Psychiatry Physician · Austin, TX
NPI 1750337259 · NPPES record last updated Nov 9, 2022
Key facts
- NPI
- 1750337259
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Psychiatry Physician 2084P0800X
- Legal business name
- AUSTIN TRAVIS COUNTY MENTAL HEALTH AND MENTAL RETARDATION CENTER
- Practice address
- 1430 Collier St
Austin, TX 78704-2911 - Phone
- (512) 472-4357
- Fax
- (512) 703-1394
- NPI assigned
- May 26, 2006
- Organization subpart
- No
Authorized official
- Name
- Dr. Ziyad B. Nuwayhid, MD
- Title
- Chief Medical Officer
- Phone
- (512) 447-4141
Other NPIs on the same Medicare enrollment 1
Other NPIs with the same Medicare PAC ID 1
Practitioners 365
-
Ziyad Bahij Nuwayhid, M.D.
-
Russell Warren Bach, M.D.
-
Molly Baker, LPC
-
Caanan Blakemore, DNP, APRN, PMHNP-BC
-
Katherine Blakemore, PMHNP-BC
-
Laura Lynn Blakley, MSN, APRN, PMHNP-BC
-
Harvey Bowers, PMHNP-BC
-
Laura Briceno, LPC
-
Jason Brown, PMHNP
-
Claudio Rene Cepeda, LPC, LCDC, NCC
-
Judith Dogbe Sey, PMHNP
-
Roxanne D. Dudley, RN, PMHNP-BC, LPC
-
Frank Duncan, PMHNP-BC
-
Kathy Duncan, PMHNP
-
Joshua Ende, PAC
-
Isimenmen Etakibuebu, DNP, M.ED., APRN
-
Esther Faith Fires, PMHNP-BC
-
Vijay Rayalu Gorrepati, M.D.
-
April M Guajardo, LCSW, LCDC
-
Lacie Jordan Hicks, LCSW
-
Elisa Yvette Hilario, APRN
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040305000036 | TX | Part B Supplier - Clinic/Group Practice | 9133016306 |
Receives reassigned benefits from 259 practitioners 1 other NPI on this enrollment Practice locations: Austin, TX |
National Provider Directory
Locations
5015 S Interstate 35
Austin, TX 78744
Phone (512) 703-1392
2501 W William Cannon Dr
Bldg 4
Austin, TX 78745
Phone (512) 804-3200
825 E Rundberg Ln
#F
Austin, TX 78753
Phone (512) 804-3900
403 E 15th St
Austin, TX 78701
Phone (512) 445-7783
6600 E Ben White Blvd
Austin, TX 78741
Phone (512) 804-3740
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor |
101YM0800X | |||
| Professional Counselor |
101YP2500X | |||
| Clinical Psychologist |
103TC0700X | |||
| Clinical Child & Adolescent Psychologist |
103TC2200X | |||
| Social Worker |
104100000X | |||
| Clinical Social Worker |
1041C0700X | |||
| Marriage & Family Therapist |
106H00000X | |||
| Case Manager/Care Coordinator |
171M00000X | |||
| Psychiatry Physician |
2084P0800X | Yes | ||
| Child & Adolescent Psychiatry Physician |
2084P0804X | |||
| Clinic/Center | 261Q00000X | |||
| Developmental Disabilities Clinic/Center | 261QD1600X | |||
| Mental Health Clinic/Center (Including Community Mental Health Center) | 261QM0801X | |||
| Physician Assistant |
363A00000X | |||
| Psychiatric/Mental Health Nurse Practitioner |
363LP0808X |
Addresses
Primary practice location
1430 Collier St
Austin, TX 78704-2911
Mailing address
1430 Collier St
Austin, TX 78704-2911
Phone (512) 447-4141
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 017413801 | Other | TX | ECI CM |
| 1335424-01 | Other | TX | MR SC |
| 1335242-02 | Other | TX | MH CM |
| 00P336 | Other | TX | BLUE CROSS BLUE SHIELD TX |
| 1335424-04 | Other | TX | MH REHAB |
| 133542405 | Medicaid | TX |
Other names
- Integral Care
NPI Registry JSON
{
"created_epoch": "1148601600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1667952000000",
"number": "1750337259",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1430 COLLIER ST",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787042911",
"telephone_number": "512-447-4141",
"fax_number": "512-440-4080"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1430 COLLIER ST",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787042911",
"telephone_number": "512-472-4357",
"fax_number": "512-703-1394"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AUSTIN TRAVIS COUNTY MENTAL HEALTH AND MENTAL RETARDATION CENTER",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-26",
"last_updated": "2022-11-09",
"certification_date": "2022-11-09",
"status": "A",
"authorized_official_last_name": "NUWAYHID",
"authorized_official_first_name": "ZIYAD",
"authorized_official_middle_name": "B.",
"authorized_official_title_or_position": "CHIEF MEDICAL OFFICER",
"authorized_official_telephone_number": "512-447-4141",
"authorized_official_name_prefix": "Dr.",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Professional",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychologist, Clinical",
"state": null,
"license": null,
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": null,
"license": null,
"primary": false
},
{
"code": "104100000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Social Worker",
"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": "106H00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Marriage & Family Therapist",
"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": "2084P0800X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": null,
"license": null,
"primary": true
},
{
"code": "2084P0804X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": null,
"license": null,
"primary": false
},
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": null,
"license": null,
"primary": false
},
{
"code": "261QD1600X",
"taxonomy_group": "",
"desc": "Clinic/Center, Developmental Disabilities",
"state": null,
"license": null,
"primary": false
},
{
"code": "261QM0801X",
"taxonomy_group": "",
"desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
"state": null,
"license": null,
"primary": false
},
{
"code": "363A00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": false
},
{
"code": "363LP0808X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Nurse Practitioner, Psychiatric/Mental Health",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ECI CM",
"identifier": "017413801",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MR SC",
"identifier": "1335424-01",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MH CM",
"identifier": "1335242-02",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD TX",
"identifier": "00P336",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MH REHAB",
"identifier": "1335424-04",
"state": "TX"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "133542405",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Integral Care",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Austin, TX
- Austin Transformational Health Inc
- Austin Transformational Health PLLC
- Austin Trauma Therapy Center
- Austin Travis County Integral Care
- Austin Travis County Mental Health and Mental Retardation Center
- Austin Travis County Mental Health and Mental Retardation Center
- Austin Travis County MHMR Center
- Austin Travis County MHMR Center
- Austin Travis County MHMR Center
- Austin Travis County MHMR Center
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 9, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.