| Organization Name: | BLUEBONNET TRAILS COMMUNITY MHMR CENTER |
| NPI Number: | 1023150877 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | NORALISA WILLIAMS (CREDENTIALING COORDINATOR) |
| Mailing Address: | 1009 N Georgetown St Round Rock |
| State: | TX US |
| Postal Code: | 786643289 |
| Phone Number: | 5122551720 |
| Fax Number: | 5122448371 |
| NPI Enumeration Date: | 02/12/2007 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0808X |
| License Number: | NO LICENSE |
| Healthcare Provider Taxonomy: (Secondary) | X |
| State: | TX |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Psych/Mental Health |
| Taxonomy Definition: | |