MEDICARE: SOS MC 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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1205565041
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOS MC LLC

Provider Business Mailing Address
First Line	:	5751 BLYTHEWOOD ST STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77021-5404
Country	:	US
Telephone Number	:	346-231-1304
Fax Number	:

Provider Business Practice Location Address
First Line	:	5751 BLYTHEWOOD ST STE 200
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77021-5404
Country	:	US
Telephone Number	:	346-217-8328
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JENICE REYES
Credential	:
Telephone Number	:	346-231-1304

Provider Enumeration Date	:	06/07/2022
Last Update Date	:	03/17/2026

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Directions to “SOS MC LLC ” Practice Location

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