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1711 E Central Texas Expy Ste 106a Killeen TX 76541-9145 | |
| (254) 599-8181 | |
| (254) 213-4200 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1711 E Central Texas Expy Ste 106a, Killeen, Texas |
| Authorized Official Name and Position | Shonda Lavon Phillips-young (PROVIDER/OWNER) |
| Authorized Official Contact | 2545998181 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1711 E Central Texas Expy Ste 106a Killeen TX 76541-9145 Ph: (254) 599-8181 | 1711 E Central Texas Expy Ste 106a Killeen TX 76541-9145 Ph: (254) 599-8181 |
| NPI Number | 1932816014 |
|---|---|
| Provider Enumeration Date | 10/31/2022 |
| Last Update Date | 05/25/2023 |
| Certification Date | 05/25/2023 |
| Medicare PECOS PAC ID | 7214307610 |
|---|---|
| Medicare Enrollment ID | O20221229001443 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932816014 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Primary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Secondary |
| Provider Name | Shonda Phillips-young |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225607310 PECOS PAC ID: 5294138319 Enrollment ID: I20210728000124 |
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