An entity, facility, or distinct part of a facility providing comprehensive, multidiscipline diagnostic, treatment, therapy, training, and counseling services to children with congenital disorders that precipitate developmental delays and in many instances mental deficiencies (e.g., Cerebral Palsy, metabolic disorders, Sturge-Weber Syndrome, etc.).
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Developmental Disabilities |
261QD1600X | |||
Counselor |
101Y00000X | |||
Dietitian, Registered |
133V00000X | 71 | Registered Dietitian or Nutrition Professional | |
Interpreter |
171R00000X | |||
Occupational Therapist |
225X00000X | 67 | Occupational Therapist in Private Practice | |
Physical Therapist |
225100000X | 65 | Physical Therapist in Private Practice | |
Speech-Language Pathologist |
235Z00000X | 15 | Speech Language Pathologist |
| NPI # | 1861534612 |
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| LBN Legal business name | BLUEBONNET TRAILS COMMUNITY MHMR CENTER | ||||||||
| Authorized official | NORALISA WILLIAMS - (CREDENTIALING COORDINATOR) | ||||||||
| Entity | Organization | ||||||||
| Organization subpart 1 | No | ||||||||
| Enumeration date | 02/12/2007 | ||||||||
| Last updated | 08/28/2023 - About 3 years ago | ||||||||
| Identifiers |
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