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103 Davis Rd Ste B League City TX 77573-2769 | |
| (832) 632-1221 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Clinic/center |
| Location | 103 Davis Rd Ste B, League City, Texas |
| Authorized Official Name and Position | Deborah Ann Simmons (CEO) |
| Authorized Official Contact | 8326321221 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
103 Davis Rd Ste B League City TX 77573-2769 Ph: (832) 632-1221 | 103 Davis Rd Ste B League City TX 77573-2769 Ph: (832) 632-1221 |
| NPI Number | 1578093613 |
|---|---|
| Provider Enumeration Date | 06/12/2017 |
| Last Update Date | 12/13/2023 |
| Certification Date | 12/13/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578093613 | NPI | - | NPPES |
| 3732810-01 | Medicaid | TX | |
| 4060121-01 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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