MEDICARE: SOUTHERN COMFORT BEHAVIORAL HEALTH CENTER, LLC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker		TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1932453008	OTHER	TX	NPI
3	1528341492	OTHER	TX	NPI

General Provider Information

NPI Number	:	1083957815
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHERN COMFORT BEHAVIORAL HEALTH CENTER, LLC.

Provider Business Mailing Address
First Line	:	9146 EASTEX FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77093-7020
Country	:	US
Telephone Number	:	832-426-4697
Fax Number	:	832-426-4996

Provider Business Practice Location Address
First Line	:	9146 EASTEX FWY
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77093-7020
Country	:	US
Telephone Number	:	832-426-4697
Fax Number	:	832-426-4996

Authorized Official
Title or Position	:	OWNER/EXECUTIVE DIRECTOR
Name	:	CHERRELLE M PHILLIPS
Credential	:
Telephone Number	:	832-969-7464

Provider Enumeration Date	:	03/29/2013
Last Update Date	:	08/24/2013

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