MEDICARE: OVERTON BROOKS HEALTH CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1083782742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OVERTON BROOKS HEALTH CENTER, LLC

Provider Business Mailing Address
First Line	:	440 BENMAR DR
Second Line	:	STE 1225
City	:	HOUSTON
State	:	TX
Zip	:	77060-3165
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	440 BENMAR DR
Second Line	:	STE 1225
City	:	HOUSTON
State	:	TX
Zip	:	77060-3165
Country	:	US
Telephone Number	:	281-999-7792
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ELVIRA B CANTU
Credential	:
Telephone Number	:	281-999-7792

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	08/22/2020

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