NPIMap

Organization Active NPI

Gulf Bend MHMR Center

  • Mental Health Counselor
  • Victoria, TX
National Provider Identifier
1912976101
Registry record updated Aug 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
Legal business name
GULF BEND MHMR CENTER
Practice address
6502 Nursery Dr
Suite 100
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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YM0800X Primary
Professional CounselorGroup: 193200000X MULTI-SPECIALTY GROUP 101YP2500X
Clinical Social WorkerGroup: 193200000X MULTI-SPECIALTY GROUP 1041C0700X

Addresses

Primary practice location

6502 Nursery Dr
Suite 100
Victoria, TX 77904-1178

Mailing address

6502 Nursery Dr
Suite 100
Victoria, TX 77904-1178
Phone (361) 575-0611

Other identifiers 1

IdentifierTypeStateIssuer
135254405MedicaidTX

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.

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": "1912976101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6502 NURSERY DR",
            "address_2": "SUITE 100",
            "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": "SUITE 100",
            "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": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "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
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "135254405",
            "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.