MEDICARE: RIVERSIDE SOUTHEAST MENTAL HEALTH CLINIC, INC.

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)
2	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1760580377
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVERSIDE SOUTHEAST MENTAL HEALTH CLINIC, INC.

Provider Business Mailing Address
First Line	:	9809 ROWLETT RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77075-3403
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9809 ROWLETT RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77075-3403
Country	:	US
Telephone Number	:	713-941-0885
Fax Number	:

Authorized Official
Title or Position	:	CEO/ADMINISTRATOR
Name	:	MRS. ANGELA HART WILLIS
Credential	:
Telephone Number	:	713-941-0090

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	09/11/2025

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