| Edify Behavioral Management Llc | |
|
2000 S Dairy Ashford Rd Ste 575 Houston TX 77077-5737 | |
| (832) 808-0425 | |
| (832) 218-0204 |
| Full Name | Edify Behavioral Management Llc |
|---|---|
| Speciality | Case Management |
| Location | 2000 S Dairy Ashford Rd Ste 575, Houston, Texas |
| Authorized Official Name and Position | Andre Lavalle Turner (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 8328080425 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Edify Behavioral Management Llc 2000 S Dairy Ashford Rd Ste 575 Houston TX 77077-5737 Ph: (832) 808-0425 | Edify Behavioral Management Llc 2000 S Dairy Ashford Rd Ste 575 Houston TX 77077-5737 Ph: (832) 808-0425 |
| NPI Number | 1174110134 |
|---|---|
| Provider Enumeration Date | 12/23/2020 |
| Last Update Date | 03/22/2024 |
| Certification Date | 03/22/2024 |
| Medicare PECOS PAC ID | 1951832914 |
|---|---|
| Medicare Enrollment ID | O20241001002214 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174110134 | NPI | - | NPPES |
| 4181307 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 251B00000X | Case Management | (* (Not Available)) | Primary |
| Provider Name | Andrew Obiomachi Onwuegbu |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1811597172 PECOS PAC ID: 6608214234 Enrollment ID: I20240402002676 |
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