Provider Demographics
NPI:1093207649
Name:MOMENTUM BEHAVIORAL HEALTH CONCEPTS, LLC
Entity Type:Organization
Organization Name:MOMENTUM BEHAVIORAL HEALTH CONCEPTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SYREETA
Authorized Official - Middle Name:
Authorized Official - Last Name:SCUDDER-EARLY
Authorized Official - Suffix:
Authorized Official - Credentials:EDD, LCDC, SAP
Authorized Official - Phone:832-865-4837
Mailing Address - Street 1:7676 HILLMONT ST STE 320
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77040-6471
Mailing Address - Country:US
Mailing Address - Phone:281-888-3977
Mailing Address - Fax:
Practice Address - Street 1:7676 HILLMONT ST STE 320
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77040-6471
Practice Address - Country:US
Practice Address - Phone:281-888-3977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-30
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX386249201Medicaid
TX386249202Medicaid