Provider Demographics
NPI:1861081549
Name:THE CHILDRENS ADVOCACY CENTER OF GREATER WEST TEXAS INC
Entity type:Organization
Organization Name:THE CHILDRENS ADVOCACY CENTER OF GREATER WEST TEXAS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-277-9198
Mailing Address - Street 1:3418 TOWN AND COUNTRY DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76903
Mailing Address - Country:US
Mailing Address - Phone:325-653-4673
Mailing Address - Fax:325-227-6896
Practice Address - Street 1:3418 TOWN AND COUNTRY DRIVE
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76903
Practice Address - Country:US
Practice Address - Phone:325-653-4673
Practice Address - Fax:325-227-6896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-15
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty