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General NPI Number Information
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NPI Number | 1669794848
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Entity Type | Organization
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Legal Business Name | ODYSSEY STABILITY SUPPORT SERVICES INC
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Dates
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Enumeration Date | 02/16/2010
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Last Update Date | 12/10/2020
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Provider Practice Location Address
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Address Line | 220 N VISTA DR
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City | HOUSTON
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State | TX
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Zip | 77073-3419
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Country | US
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Telephone | 281-787-1429
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Fax | 281-444-1134
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Provider Business Mailing Address
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Address Line | 220 N VISTA DR
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City | HOUSTON
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State | TX
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Zip | 77073-3419
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Country | US
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Telephone | 281-787-1429
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Fax | 281-444-1134
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Authorized Official
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Title or Position | OPERATIONS OFFICER
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Name | DIMITRA KELLUM
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Credential |
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Telephone | 281-787-1429
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 #2
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare 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 | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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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 | 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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