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805 North Dickinson Rusk TX 75785-0318 | |
| (903) 683-7201 | |
| (903) 683-7199 |
| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 805 North Dickinson, Rusk, Texas |
| Authorized Official Name and Position | Jana Johnson (ACCOUNTANT III) |
| Authorized Official Contact | 5122065284 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4110 Guadalupe St Hospital Revenue Mgmt-mc2023 Austin TX 78751-4223 Ph: (512) 206-5284 | 805 North Dickinson Rusk TX 75785-0318 Ph: (903) 683-7201 |
| NPI Number | 1639182967 |
|---|---|
| Provider Enumeration Date | 08/15/2006 |
| Last Update Date | 08/25/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639182967 | NPI | - | NPPES |
| HH4588 | Other | TX | BCBS PSYCHIATRIC |
| 0827925-01 | Medicaid | TX | |
| HH3006 | Other | TX | BCBS DRUG/ALCOHOL |
| 0638231-01 | Medicaid | TX | |
| 1333312-01 | Medicaid | TX | |
| 1333312-02 | Medicaid | TX | |
| 1333312-03 | Medicaid | TX | |
| 4537835 | Other | TX | PHARMACY NCPDP |
Coastal Kids Autism Treatment Center, Llc Mental Health Clinic Medicare: Not Enrolled in Medicare Practice Location: 115 Tiffany St, Rusk, TX 75785 Phone: 903-805-9363 |