Provider Demographics
NPI:1376150839
Name:VICTORIA BEHAVIORAL SERVICES CLINIC LLC
Entity Type:Organization
Organization Name:VICTORIA BEHAVIORAL SERVICES CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:EZERA
Authorized Official - Last Name:NWOJO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-902-7580
Mailing Address - Street 1:16205 WESTHEIMER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77082-1207
Mailing Address - Country:US
Mailing Address - Phone:281-293-9200
Mailing Address - Fax:281-293-9203
Practice Address - Street 1:16205 WESTHEIMER RD STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-1207
Practice Address - Country:US
Practice Address - Phone:281-293-9200
Practice Address - Fax:281-293-9203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-29
Last Update Date:2023-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health