Healthcare Provider Details

I. General information

NPI: 1801553342
Provider Name (Legal Business Name): MOMENTUM MINDS BEHAVIORAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2021
Last Update Date: 03/28/2022
Certification Date: 03/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21306 RUSSELL CHASE DR
PORTER TX
77365-7114
US

IV. Provider business mailing address

21306 RUSSELL CHASE DR
PORTER TX
77365-7114
US

V. Phone/Fax

Practice location:
  • Phone: 832-815-8929
  • Fax:
Mailing address:
  • Phone: 832-815-8929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MS. YANEKA N. WALKER
Title or Position: CEO
Credential:
Phone: 832-815-8929