Provider Demographics
NPI:1083957815
Name:SOUTHERN COMFORT BEHAVIORAL HEALTH CENTER, LLC.
Entity Type:Organization
Organization Name:SOUTHERN COMFORT BEHAVIORAL HEALTH CENTER, LLC.
Other - Org Name:SOUTHERN COMFORT BHC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHERRELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-969-7464
Mailing Address - Street 1:9146 EASTEX FWY
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77093-7020
Mailing Address - Country:US
Mailing Address - Phone:832-426-4697
Mailing Address - Fax:832-426-4996
Practice Address - Street 1:9146 EASTEX FWY
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77093-7020
Practice Address - Country:US
Practice Address - Phone:832-426-4697
Practice Address - Fax:832-426-4996
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-29
Last Update Date:2013-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193116404Medicaid
TX1932453008OtherNPI
TX1528341492OtherNPI