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General NPI Number Information
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NPI Number | 1639061609
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Entity Type | Organization
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Legal Business Name | OMNIA HEALTH COLLECTIVE
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Dates
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Enumeration Date | 07/16/2025
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Last Update Date | 11/28/2025
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Provider Practice Location Address
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Address Line | 3100 WESLAYAN ST STE 380
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City | HOUSTON
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State | TX
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Zip | 77027-5736
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Country | US
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Telephone | 713-498-2112
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Fax |
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Provider Business Mailing Address
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Address Line | 1319 RICHMOND AVE UNIT 667603
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City | HOUSTON
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State | TX
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Zip | 77266-0073
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Country | US
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Telephone | 713-498-2112
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DERIC DEMOND OUTLEY
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Credential | RN
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Telephone | 713-498-2112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics 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 | 261QR0405X
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Taxonomy Name | Substance Use Disorder Rehabilitation Clinic/Center
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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 | 2083P0901X
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Taxonomy Name | Public Health & General Preventive Medicine Physician
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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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 | 261QP3300X
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Taxonomy Name | Pain 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 | 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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