Provider Demographics
NPI:1669794848
Name:ODYSSEY STABILITY SUPPORT SERVICES INC
Entity type:Organization
Organization Name:ODYSSEY STABILITY SUPPORT SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DIMITRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-787-1429
Mailing Address - Street 1:220 N VISTA DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77073-3419
Mailing Address - Country:US
Mailing Address - Phone:281-787-1429
Mailing Address - Fax:281-444-1134
Practice Address - Street 1:220 N VISTA DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77073-3419
Practice Address - Country:US
Practice Address - Phone:281-787-1429
Practice Address - Fax:281-444-1134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-16
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase Management
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No251K00000XAgenciesPublic Health or Welfare
No305R00000XManaged Care OrganizationsPreferred Provider Organization