Provider Demographics
NPI:1225689185
Name:PLATFORM BEHAVIORAL SUPPORT SERVICES LLC
Entity Type:Organization
Organization Name:PLATFORM BEHAVIORAL SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:IZEKOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-729-3198
Mailing Address - Street 1:9896 BISSONNET ST STE 410
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8155
Mailing Address - Country:US
Mailing Address - Phone:713-360-7375
Mailing Address - Fax:
Practice Address - Street 1:9896 BISSONNET ST STE 410
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8155
Practice Address - Country:US
Practice Address - Phone:919-749-6373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-23
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty