Provider Demographics
NPI:1700937869
Name:EL PASO PSYCHIATRIC ASSOCIATES PA
Entity type:Organization
Organization Name:EL PASO PSYCHIATRIC ASSOCIATES PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:J
Authorized Official - Last Name:ANDERSON-JIMENEZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, PMHNP-BC
Authorized Official - Phone:915-757-7999
Mailing Address - Street 1:7760 ALABAMA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79904-3136
Mailing Address - Country:US
Mailing Address - Phone:915-757-7999
Mailing Address - Fax:915-757-8004
Practice Address - Street 1:7760 ALABAMA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79904-3136
Practice Address - Country:US
Practice Address - Phone:915-757-7999
Practice Address - Fax:915-757-8004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX875-A261QM0850X, 261QM0855X, 261QR0405X
261QM0850X, 261QM0855X, 261QR0405X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH5066OtherBLUE CROSS BLUE SHIELD
TX021302701Medicaid
TXHH6759OtherBLUE CROSS BLUE SHIELD OF
TXHH6759OtherBLUE CROSS BLUE SHIELD OF