| Diverse Behavioral Health Group | |
|
11971 N Grand Pkwy E Ste 200207 New Caney TX 77357-1827 | |
| (346) 471-5200 | |
| (346) 474-0990 |
| Full Name | Diverse Behavioral Health Group |
|---|---|
| Speciality | Counselor |
| Location | 11971 N Grand Pkwy E Ste 200207, New Caney, Texas |
| Authorized Official Name and Position | Kimm M. Perez (OWNER) |
| Authorized Official Contact | 3464715200 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Diverse Behavioral Health Group 11971 N Grand Pkwy E Ste 200207 New Caney TX 77357-1827 Ph: (346) 471-5200 | Diverse Behavioral Health Group 11971 N Grand Pkwy E Ste 200207 New Caney TX 77357-1827 Ph: (346) 471-5200 |
| NPI Number | 1861126005 |
|---|---|
| Provider Enumeration Date | 07/13/2022 |
| Last Update Date | 03/27/2024 |
| Certification Date | 03/27/2024 |
| Medicare PECOS PAC ID | 7214374933 |
|---|---|
| Medicare Enrollment ID | O20240318001459 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861126005 | NPI | - | NPPES |
| 336059606 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| 103TC1900X | Psychologist - Counseling | (* (Not Available)) | Secondary |
| Provider Name | Kimm M. Perez |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1013321090 PECOS PAC ID: 6507218013 Enrollment ID: I20240120000244 |
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