| Coastal Plains Community Center | |
|
200 Marriott Dr Portland TX 78374-2213 | |
| (361) 777-3991 | |
| (361) 777-0610 |
| Full Name | Coastal Plains Community Center |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 200 Marriott Dr, Portland, Texas |
| Authorized Official Name and Position | Leonel Trejo (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 3617773991 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Coastal Plains Community Center Po Box 1336 Portland TX 78374-1185 Ph: (361) 777-3991 | Coastal Plains Community Center 200 Marriott Dr Portland TX 78374-2213 Ph: (361) 777-3991 |
| NPI Number | 1962552109 |
|---|---|
| Provider Enumeration Date | 01/11/2007 |
| Last Update Date | 06/14/2023 |
| Certification Date | 06/14/2023 |
| Medicare PECOS PAC ID | 1557337490 |
|---|---|
| Medicare Enrollment ID | O20040902000680 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962552109 | NPI | - | NPPES |
| 080368601 | Medicaid | TX |
| Provider Name | Krishnaiah Rayasam |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1831188903 PECOS PAC ID: 6204802143 Enrollment ID: I20040902000667 |
| Provider Name | Rebecca Ann Kraatz |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1285773184 PECOS PAC ID: 2860455953 Enrollment ID: I20080109000118 |
| Provider Name | Michael Escamilla |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801903893 PECOS PAC ID: 0547317778 Enrollment ID: I20090406000077 |
| Provider Name | Umamaheswara Rao Maruvada |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053300103 PECOS PAC ID: 5799835765 Enrollment ID: I20090612000290 |
| Provider Name | Murthy V.s. Mangipudi |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1558350603 PECOS PAC ID: 3678615739 Enrollment ID: I20100127000764 |
| Provider Name | Henry Weisman |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1801884895 PECOS PAC ID: 1850339102 Enrollment ID: I20100326000351 |
| Provider Name | Delisa Guadarrama |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1356637227 PECOS PAC ID: 6103106745 Enrollment ID: I20161216001612 |
| Provider Name | Alcides Amador |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1417338286 PECOS PAC ID: 4183902679 Enrollment ID: I20200611003038 |
| Provider Name | Sason D Tavakoli-sabour |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1649626706 PECOS PAC ID: 3375963093 Enrollment ID: I20201020000236 |
| Provider Name | Norma V Vela |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568129153 PECOS PAC ID: 7214327949 Enrollment ID: I20211210002169 |
| Provider Name | Johanna Villasenor Nardini |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1780046839 PECOS PAC ID: 7911292156 Enrollment ID: I20220126000358 |
| Provider Name | Mary Ellen Mchugh |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1376874743 PECOS PAC ID: 9436331998 Enrollment ID: I20220503002492 |
| Provider Name | Rachael Marie Loudon-castillo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992376438 PECOS PAC ID: 4587036470 Enrollment ID: I20230201002780 |
| Provider Name | Mary Lisa Duarte |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568140366 PECOS PAC ID: 0345604757 Enrollment ID: I20230918002162 |
| Provider Name | Michelle Kay Hlavik |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1417145699 PECOS PAC ID: 7810348885 Enrollment ID: I20240104001323 |
| Provider Name | Belinda Guerrero |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1538559141 PECOS PAC ID: 5294186490 Enrollment ID: I20240112000578 |
| Provider Name | Melanie Deann Gracia |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1972295566 PECOS PAC ID: 5395196406 Enrollment ID: I20240112001248 |
| Provider Name | Iris Diana Beltran |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1497465702 PECOS PAC ID: 5294187381 Enrollment ID: I20240112004164 |
| Provider Name | Richard Gerard Sanchez |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1871773945 PECOS PAC ID: 6800248097 Enrollment ID: I20240124000695 |
| Provider Name | Jonathan Marcus Heyward |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1043627029 PECOS PAC ID: 6406299239 Enrollment ID: I20240208003632 |
| Provider Name | Joel Jaime Johnson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1568675981 PECOS PAC ID: 7810330552 Enrollment ID: I20240208004258 |
| Provider Name | Celina Utley |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1396360970 PECOS PAC ID: 8820431448 Enrollment ID: I20240209002882 |
| Provider Name | Linda Lee Madrigal Garza |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1780301325 PECOS PAC ID: 0547603003 Enrollment ID: I20240212002909 |
| Provider Name | Linda Ramos Perez |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1477281004 PECOS PAC ID: 4183068091 Enrollment ID: I20240220000652 |
| Provider Name | Grover Cleavon Rollins |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1568584381 PECOS PAC ID: 9436591963 Enrollment ID: I20240529001656 |
| Provider Name | Stephanie Renee Mccoy |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1003655705 PECOS PAC ID: 9739621020 Enrollment ID: I20240601000069 |
Coastal Plains Community Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 200 Marriott Dr, Portland, TX 78374 Phone: 361-777-3991 Fax: 361-777-0610 | |
Richard L Reitmann Lpc Pllc Mental Health Clinic Medicare: Medicare Enrolled Practice Location: 1700 Wildcat Dr Ste D, Portland, TX 78374 Phone: 361-445-4080 | |
Coastal Plains Community Center Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 200 Marriott Drive, Portland, TX 78374 Phone: 361-777-3991 Fax: 361-777-0610 | |
Coastal Plains Community Mhmr Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 200 Marriott Dr, Portland, TX 78374 Phone: 361-777-3991 | |
Mary Ann Gansle Sole Mbr Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 1700 Wildcat Dr Ste D, Portland, TX 78374 Phone: 361-445-4080 Fax: 888-413-3010 |