Healthcare Provider Details

I. General information

NPI: 1366182164
Provider Name (Legal Business Name): GRAND VISTA BEHAVIORAL HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 05/01/2022
Certification Date: 05/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9711 S MASON RD STE 125-215
RICHMOND TX
77407-7167
US

IV. Provider business mailing address

9711 S MASON RD STE 125-215
RICHMOND TX
77407-7167
US

V. Phone/Fax

Practice location:
  • Phone: 346-933-2463
  • Fax: 713-234-7382
Mailing address:
  • Phone: 346-933-2463
  • Fax: 713-234-7382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: BLESSING UCHECHUKWU SMITH
Title or Position: PMHNP-BC
Credential: APRN
Phone: 832-352-0845