NPIMap

Organization Active NPI

Mhmra of Brazos Valley

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Bryan, TX
National Provider Identifier
1881621225
Registry record updated Mar 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X
Legal business name
MHMRA OF BRAZOS VALLEY
Practice address
804 S Texas Ave
Bryan, TX 77803-3946
Phone
(979) 822-6467
Fax
(979) 821-9448
NPI assigned
Jun 28, 2006
Last updated
Mar 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 26, 2024

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

Authorized official

Name
Mr. Bill Kelly
Title
Executive Director
Phone
(979) 822-6467

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X TX Primary

Addresses

Primary practice location

804 S Texas Ave
Bryan, TX 77803-3946

Mailing address

1504 Texas Ave.
Bryan, TX 77805-1504
Phone (979) 822-6467

Other identifiers 6

IdentifierTypeStateIssuer
136366502MedicaidTX
136366505MedicaidTX
136366501MedicaidTX
136366504MedicaidTX
136366506MedicaidTX
136366507MedicaidTX

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040726000466 TX Part B Supplier - Clinic/Group Practice 8123008505 Receives reassigned benefits from 12 practitioners
Practice locations: Bryan, TX

National Provider Directory

National Provider Directory

Locations

305 N Park St
Brenham, TX 77833
Phone (979) 836-4714

605 E Blue Bell Rd
Brenham, TX 77833

804 N Texas Ave
Bryan, TX 77803
Phone (409) 822-6467

103 E Highway 21
Caldwell, TX 77836

1212 W Brown St
Hearne, TX 77859
Phone (979) 279-5193

109 W Trinity St
Madisonville, TX 77864
Phone (936) 348-3695

3438 Highway 21 E
Madisonville, TX 77864
Phone (409) 822-6467

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1711411200000",
    "number": "1881621225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1504 TEXAS AVE.",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778051504",
            "telephone_number": "979-822-6467",
            "fax_number": "979-821-9448"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "804 S TEXAS AVE",
            "city": "BRYAN",
            "state": "TX",
            "postal_code": "778033946",
            "telephone_number": "979-822-6467",
            "fax_number": "979-821-9448"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MHMRA OF BRAZOS VALLEY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-28",
        "last_updated": "2024-03-26",
        "certification_date": "2024-03-26",
        "status": "A",
        "authorized_official_last_name": "KELLY",
        "authorized_official_first_name": "BILL",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "979-822-6467",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": "TX",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "136366502",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "136366505",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "136366501",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "136366504",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "136366506",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "136366507",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bryan, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2024; 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.