Healthcare Provider Details

I. General information

NPI: 1013871052
Provider Name (Legal Business Name): ETAGE D'AMOUR BEHAVIORAL HEALTHCARE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13303 REDWOOD TRAIL LN
ROSHARON TX
77583-0436
US

IV. Provider business mailing address

13303 REDWOOD TRAIL LN
ROSHARON TX
77583-0436
US

V. Phone/Fax

Practice location:
  • Phone: 346-219-7516
  • Fax:
Mailing address:
  • Phone: 346-219-7516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: AMINU SUFU MAHMUD
Title or Position: PRESIDENT
Credential: PMHNP
Phone: 346-219-7516