Provider Demographics
NPI:1518719756
Name:9INE4LYF BEHAVIORAL SOLUTIONS
Entity Type:Organization
Organization Name:9INE4LYF BEHAVIORAL SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN-PMHNP-BC
Authorized Official - Prefix:
Authorized Official - First Name:IFEOMA
Authorized Official - Middle Name:NELLY
Authorized Official - Last Name:UDE-OKORO
Authorized Official - Suffix:
Authorized Official - Credentials:DNP,FNP-C,PMHNP-BC
Authorized Official - Phone:979-243-9381
Mailing Address - Street 1:9888 BISSONNET ST STE 200
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77036-8248
Mailing Address - Country:US
Mailing Address - Phone:979-243-9381
Mailing Address - Fax:
Practice Address - Street 1:9888 BISSONNET ST STE 200
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77036-8248
Practice Address - Country:US
Practice Address - Phone:979-243-9381
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1124508478Medicaid