| Organization Name: | DEPARTMENT OF STATE HEALTH SERVICES |
| NPI Number: | 1639182967 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HECTOR C. BALTIERRA (TEAM LEAD) |
| Mailing Address: | 805 North Dickinson Rusk |
| State: | TX US |
| Postal Code: | 757850318 |
| Phone Number: | 9036837201 |
| Fax Number: | 9036837199 |
| NPI Enumeration Date: | 08/15/2006 |
| NPI Last Update Date: | 04/05/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |