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General NPI Number Information
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NPI Number | 1932453008
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Entity Type | Organization
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Legal Business Name | SOUTHERN COMFORT BEHAVIORAL HEALTH CENTER
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Dates
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Enumeration Date | 10/29/2012
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Last Update Date | 10/29/2012
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Provider Practice Location Address
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Address Line | 7119 VILLAGE WAY
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City | HOUSTON
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State | TX
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Zip | 77087-2904
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Country | US
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Telephone | 832-689-8770
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Fax |
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Provider Business Mailing Address
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Address Line | 7119 VILLAGE WAY
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City | HOUSTON
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State | TX
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Zip | 77087-2904
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Country | US
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Telephone | 832-689-8770
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | CHERRELLE M PHILLIPS
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Credential |
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Telephone | 832-689-8770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 01607528
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License Number State | TX
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