MEDICARE: SECOND CHANCE HEALTHCARE

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1548141724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SECOND CHANCE HEALTHCARE

Provider Business Mailing Address
First Line	:	5625 WOODROW BEAN
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79924-4142
Country	:	US
Telephone Number	:	901-650-5374
Fax Number	:	901-650-5374

Provider Business Practice Location Address
First Line	:	5625 WOODROW BEAN
Second Line	:
City	:	EL PASO
State	:	TX
Zip	:	79924-4142
Country	:	US
Telephone Number	:	901-650-5374
Fax Number	:	901-650-5374

Authorized Official
Title or Position	:	BEHAVIOR HEALTH TECH
Name	:	MARILYN ROCHELLE SIMPSON
Credential	:	BEHAVIOR HEALTH
Telephone Number	:	901-650-5374

Provider Enumeration Date	:	09/11/2025
Last Update Date	:	09/11/2025

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