Provider Demographics
NPI:1295313963
Name:SIMSO BEHAVIORAL LEGACY, LLC.
Entity type:Organization
Organization Name:SIMSO BEHAVIORAL LEGACY, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NKEM
Authorized Official - Middle Name:
Authorized Official - Last Name:OKOLI
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:240-351-7546
Mailing Address - Street 1:20119 GOSS HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-0039
Mailing Address - Country:US
Mailing Address - Phone:240-351-7546
Mailing Address - Fax:
Practice Address - Street 1:20119 GOSS HOLLOW LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77449-0039
Practice Address - Country:US
Practice Address - Phone:240-351-7546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-01
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty