Provider Demographics
NPI:1932761897
Name:ETHOS PRISM, LLC
Entity Type:Organization
Organization Name:ETHOS PRISM, LLC
Other - Org Name:THE PRISM CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HILLIKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-922-2058
Mailing Address - Street 1:6750 WEST LOOP S STE 950
Mailing Address - Street 2:
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4124
Mailing Address - Country:US
Mailing Address - Phone:832-778-6750
Mailing Address - Fax:
Practice Address - Street 1:6750 WEST LOOP S STE 950
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4124
Practice Address - Country:US
Practice Address - Phone:713-470-9878
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-01
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health