MEDICARE: DANSHALOM BEHAVIORAL CLINIC 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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

General Provider Information

NPI Number	:	1700736584
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DANSHALOM BEHAVIORAL CLINIC LLC

Provider Business Mailing Address
First Line	:	4830 SILVERLAKE DR
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-5252
Country	:	US
Telephone Number	:	346-855-6216
Fax Number	:	582-998-2896

Provider Business Practice Location Address
First Line	:	4830 SILVERLAKE DR
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77479-5252
Country	:	US
Telephone Number	:	346-855-6216
Fax Number	:	582-998-2896

Authorized Official
Title or Position	:	CEO
Name	:	VICTOR ONODJACHA
Credential	:
Telephone Number	:	346-855-6216

Provider Enumeration Date	:	01/30/2026
Last Update Date	:	03/23/2026

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