Provider Demographics
NPI:1053048033
Name:OPAMEN PRACTICE PLLC
Entity type:Organization
Organization Name:OPAMEN PRACTICE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:R
Authorized Official - Last Name:OPAMEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-630-0567
Mailing Address - Street 1:11719 BEE CAVES RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BEE CAVE
Mailing Address - State:TX
Mailing Address - Zip Code:78738-5540
Mailing Address - Country:US
Mailing Address - Phone:737-301-9007
Mailing Address - Fax:
Practice Address - Street 1:11719 BEE CAVES RD STE 200
Practice Address - Street 2:
Practice Address - City:BEE CAVE
Practice Address - State:TX
Practice Address - Zip Code:78738-5540
Practice Address - Country:US
Practice Address - Phone:737-301-8668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-01
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1467060244Medicaid