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General NPI Number Information
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NPI Number | 1174110134
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Entity Type | Organization
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Legal Business Name | EDIFY BEHAVIORAL MANAGEMENT LLC
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Dates
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Enumeration Date | 12/23/2020
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Last Update Date | 03/07/2026
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Provider Practice Location Address
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Address Line | 2000 S DAIRY ASHFORD RD STE 575
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City | HOUSTON
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State | TX
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Zip | 77077-5737
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Country | US
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Telephone | 832-808-0425
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Fax | 832-218-0204
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Provider Business Mailing Address
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Address Line | 2000 S DAIRY ASHFORD RD STE 575
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City | HOUSTON
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State | TX
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Zip | 77077-5737
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Country | US
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Telephone | 832-808-0425
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Fax | 832-218-0204
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Authorized Official
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Title or Position | CREDENTIALING
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Name | SHERIE BANOVIC
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Credential |
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Telephone | 832-767-8551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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