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General NPI Number Information
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NPI Number | 1346010618
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Entity Type | Organization
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Legal Business Name | PRESIDIO BEHAVIORAL HEALTH AND WELLNESS, LLC
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Dates
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Enumeration Date | 01/08/2024
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 14602 PRESIDIO SQUARE BLVD
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City | HOUSTON
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State | TX
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Zip | 77083-1654
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Country | US
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Telephone | 832-492-6842
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Fax |
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Provider Business Mailing Address
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Address Line | 14602 PRESIDIO SQUARE BLVD
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City | HOUSTON
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State | TX
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Zip | 77083-1654
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Country | US
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Telephone | 832-492-6842
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. KATHY DAVIS
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Credential | FNP-BC
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Telephone | 832-492-6842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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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 | 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 #3
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #8
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #9
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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Taxonomy #10
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number |
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License Number State |
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