| Victoria Behavioral Services Clinic Llc | |
|
16205 Westheimer Rd Ste 100 Houston TX 77082-1207 | |
| (281) 293-9200 | |
| (281) 293-9203 |
| Full Name | Victoria Behavioral Services Clinic Llc |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 16205 Westheimer Rd Ste 100, Houston, Texas |
| Authorized Official Name and Position | Samuel Ezera Nwojo (ADMINISTRATOR) |
| Authorized Official Contact | 2819027580 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Victoria Behavioral Services Clinic Llc 16205 Westheimer Rd Ste 100 Houston TX 77082-1207 Ph: (281) 293-9200 | Victoria Behavioral Services Clinic Llc 16205 Westheimer Rd Ste 100 Houston TX 77082-1207 Ph: (281) 293-9200 |
| NPI Number | 1376150839 |
|---|---|
| Provider Enumeration Date | 09/29/2020 |
| Last Update Date | 12/09/2023 |
| Certification Date | 12/09/2023 |
| Medicare PECOS PAC ID | 5193194983 |
|---|---|
| Medicare Enrollment ID | O20221219000998 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376150839 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Kenisha T Rotibi |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1679029136 PECOS PAC ID: 1254629033 Enrollment ID: I20161011001306 |
| Provider Name | Juan Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1760659551 PECOS PAC ID: 6507938123 Enrollment ID: I20221228001282 |
| Provider Name | Esther Idowu Ajayi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1639646219 PECOS PAC ID: 0547630550 Enrollment ID: I20230110000138 |
| Provider Name | Titi F Oyawusi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215686738 PECOS PAC ID: 4284099623 Enrollment ID: I20230508001740 |
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