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General NPI Number Information
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NPI Number | 1487019816
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Entity Type | Organization
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Legal Business Name | PREFERRED BEHAVIORAL HEALTH PLLC
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Dates
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Enumeration Date | 12/30/2015
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Last Update Date | 08/17/2022
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Provider Practice Location Address
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Address Line | 424 PARK GROVE LANE
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City | KATY
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State | TX
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Zip | 77450-1571
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Country | US
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Telephone | 832-913-3765
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Fax | 832-913-6534
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Provider Business Mailing Address
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Address Line | 3407 GRAND PEBBLE LN
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City | KATY
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State | TX
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Zip | 77494-0707
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MD/CEO
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Name | DR. BENJAMIN WOWO
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Credential | MD
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Telephone | 917-434-7735
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number | P9770
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number | P9770
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License Number State | TX
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